Hypotensive Treatment Research Articles

Microshunt preserflo revision by anterior vitrectomy

Aims/Purpose: To describe a clinical case involving the obstruction of a glaucoma drainage device (GDD) caused by the presence of vitreous in the anterior chamber, a rare cause of this type of obstruction.Methods: We report the case of a 79‐year‐old patient with pseudoexfoliative secondary open‐angle glaucoma in the left eye. Despite being under hypotensive treatment with four active principles, the patient showed poor intraocular pressure (IOP) control and progression of glaucomatous damage. It was decided to implant a PreserFlo MicroShunt. During the preoperative examination, vitreous strands and capsular debris were evident in the anterior chamber, probably due to zonular dehiscence secondary to previous cataract surgery. Although the PreserFlo MicroShunt implantation and drainage bleb were performed correctly, the IOP remained elevated in the first week. Obstruction of the valvular tube by the vitreous strand was identified as the cause of GDD failure.Initially, conservative treatment with YAG laser vitreolysis was attempted but was not effective. Therefore, a new surgical intervention consisting of anterior vitrectomy, revision of the valvular tube and drainage bleb was proposed. During surgery, triamcinolone acetonide was used to stain the vitreous, as well as brilliant blue to check the patency of the valvular tube. The leakage bleb and the most distal portion of the tube were checked by conjunctival dissection and Tenon's capsule.Results: As a result of the surgical intervention, the patient was able to achieve the target IOP. Future revisions are expected to confirm stabilization of glaucomatous damage.Conclusions: In conclusion, the vitreous and capsular debris should be removed by performing a wide anterior vitrectomy prior to GDD placement if necessary. YAG laser vitreolysis may be a temporary solution, but anterior vitrectomy ensures long‐lasting patency of the drainage device.

Latanoprost in the treatment of primary open-angle glaucoma

Latanoprost, an analogue of class F2α prostaglandins, has been on the glaucoma hypotensive treatment market for almost 30 years, being the drug of first choice due to its high efficiency, good tolerability and minimal dosage. The drug is effective in all ages and is approved in pediatric practice from 1 year. According to numerous studies, latanoprost monotherapy can reduce IOP by an average of 22–39 % from the initial level over several years; a decrease in the hypotensive effect over time has not been noted. Latanoprost is compatible with all other groups of antiglaucoma drugs, demonstrating an additive effect.

Efficacy and safety of 0.1 % brimonidine as a starting monotherapy and when added to combination therapy of glaucoma

Purpose: to analyze the efficacy and safety of Santabrim® as a starting monotherapy and when added to combination therapy for glaucoma.Material and methods. The study was conducted on 60 patients (60 eyes), including 21 (35 %) men and 39 (65 %) women, with initial or advanced primary open-angle glaucoma with moderately elevated IOP. The average age of patients was 63.4 years. The first group (30 eyes) consisted of patients who were prescribed Santabrim® 2 times a day as a starting monotherapy. The second group consisted of patients (30 eyes) who had an enhanced regimen using Santabrim® 2 times a day as a third drug. To analyze the hypotensive effect, the data of corneally compensated IOP were compared at the first visit and 1 month after the appointment or enhancement of the local hypotensive regimen. Safety was assessed by comparing the degree of fluorescein staining of the cornea, conjunctival hyperemia, OSDI questionnaire indicators and the level of adherence to treatment at the appropriate time in two groups of patients.Results. Santabrim® significantly reduces the level of IOP. The use of the drug as monotherapy allows to reduce IOP by 26.3 % of the initial level. Strengthening combination therapy by adding Santabrem® as a third drug allows reducing the level of IOP by an additional 15.9 %. Objective indicators of the condition of the tissues of the anterior surface of the eye have not changed significantly. Based on the results of the assessment of the main signs of dry eye syndrome (OSDI) and the degree of patient adherence to treatment, no significant changes were revealed.Conclusion. Brimonidine 0.1 % (Santabrim®) can be recommended for the hypotensive treatment of glaucoma both in monotherapy and in combination with other groups of local instillation drugs, and its direct neuroprotective effect additionally contributes to the stabilization of glaucoma opticoneuropathy.

Comparing the cardiorespiratory safety of parenteral olanzapine and benzodiazepines to parenteral haloperidol/droperidol and benzodiazepines in emergency department patients

IntroductionThis study sought to assess the cardiorespiratory safety of parenteral olanzapine and benzodiazepine combination treatment compared to parenteral droperidol or haloperidol and benzodiazepine combination treatment. Materials and methodsThis was a retrospective chart review conducted in adult emergency department patients who received intramuscular (IM) or intravenous (IV) droperidol, haloperidol, or olanzapine within one hour of IM or IV benzodiazepine. Patients were stratified into groups based on whether they received either olanzapine in combination with a benzodiazepine (n = 48) or droperidol or haloperidol in combination with a benzodiazepine (n = 48). ResultsPatients in each group had a decrease in their systolic blood pressure (SBP) after IM/IV olanzapine and IM/IV droperidol or haloperidol when used in combination with an IM/IV benzodiazepine ((Olanzapine + benzodiazepine (mmHg), median (IQR): Pre-SBP: 132 (117–151) vs. Post-SBP: 117 (99–131), p < 0.01) (Droperidol or haloperidol + benzodiazepine (mmHg), median (IQR): Pre-SBP: 138 (122–149) vs. Post-SBP: 106 (98–127), p < 0.01)). Both groups had similar percent SBP decreases post-combination treatment (Olanzapine + benzodiazepine (15.6 %) vs. Droperidol or haloperidol + benzodiazepine (15.2 %); p = 0.55). We did not observe any statistically significant between group differences for hypotension (Olanzapine + benzodiazepine: 1/48, 2.1 % vs. Droperidol or haloperidol + benzodiazepine: 3/48, 6.3 %; p = 0.62)), escalation in oxygen requirements (Olanzapine + benzodiazepine: 7/48, 14.6 %) vs. Droperidol or haloperidol + benzodiazepine: 5/48, 10.4 %; p = 0.76)), or intubation due to cardiorespiratory depression (Olanzapine + benzodiazepine: 0/0, 0 % vs. Droperidol or haloperidol + benzodiazepine: 0/0, 0 %; p = 1.00)). ConclusionThis study found decreases in SBP after administering parenteral olanzapine and parenteral droperidol or haloperidol in combination with a parenteral benzodiazepine. The percent change in SBP and the frequency of hypotensive episodes post-combination treatment were not different between groups. There were also no differences between groups in need of increased oxygen requirements post-combination treatment or need for intubation due to cardiorespiratory depression. This study suggests parenteral olanzapine in combination with a parenteral benzodiazepine may have comparable cardiorespiratory safety versus parenteral droperidol or haloperidol in combination with a parenteral benzodiazepine when treating agitation in the adult ED.

Surgical Outcomes in Uveitic Glaucoma: Long-Term Evaluation of Trabeculectomy, Non-Penetrating Deep Sclerectomy, Ex-PRESS Shunt and Ahmed Glaucoma Valve. A 3-Year Follow-Up Study

ABSTRACT Purpose Uveitis can lead to secondary glaucoma, a condition with challenging management that can carry irreversible visual loss. Filtering surgery has demonstrated a higher failure rate, increased incidence of postoperative complications and reinterventions in uveitic patients. There is no consensus on the optimal surgical approach for uveitic glaucoma (UG) due to limited data comparing various intraocular pressure (IOP)-lowering surgeries. This retrospective cohort aims to assess the clinical outcomes of trabeculectomy (TBT), non-penetrating deep sclerectomy (NPDS), Ex-PRESS shunt and Ahmed glaucoma valve, providing additional insights into the long-term IOP control and safety of filtering surgeries in UG. Methods The filtering surgery was performed on 32 eyes of 27 UG patients. Complete success was defined as IOP ≤ 18 mmHg or a 30% reduction. Qualified success allowed topical hypotensive treatment. Results Complete success was 40.63% (13/32) at 12 months and 36.67% (11/30) at 36 months. Qualified success was 84.38% (27/32) at 12 months and 63.33% (19/30) at 36 months. In the survival analysis, both NPDS and Ex-PRESS demonstrated decreased failure rates compared to TBT (NPDS vs TBT: HR = 0.20, p = 0.049; Ex-PRESS vs TBT: HR = 0.28, p = 0.13). One or more reinterventions were required in 34.38% (11/32) of the eyes. NPDS had the lowest incidence of hypotony. Secondary cataract was a common complication in all groups. Conclusion Various filtering surgeries are safe and effective procedures for lowering IOP and reducing the requirement of topical antihypertensives in UG at 36 months. However, one-third of the patients will require another IOP-lowering procedure.

Visual field progression patterns in the ocular hypertension treatment study correspond to vulnerability regions of the disc.

To determine the locations on the 24-2 visual field (VF) testing grid that are most likely to progress in patients with ocular hypertension (OHTN). Based on a structural model of superior and inferior areas of relative vulnerability at the optic disc, we hypothesized that the nasal and paracentral regions are more prone to show a reduction in sensitivity. Posthoc analysis of data collected in phases 1 and 2 of the Ocular Hypertension Treatment Study (OHTS). A pointwise analysis was applied to determine the progression patterns in the early and delayed treatment groups. Each group's progression rate and frequency were calculated for each of the 52 locations corresponding to the 24-2 VF strategy, using trend- and event-based analyses, respectively. For the event-based analysis, the events were most commonly found in the nasal and paracentral regions. The same regions, with some modest variation, were found to have the fastest rates of progression (ROP) measured with trend analysis. A similar pattern of progression was observed in both the early and delayed treatment groups. The difference in event rates and ROP between the early and delayed treatment groups was also greatest in the nasal and paracentral regions. Development of VF loss in ocular hypertensive eyes appears to be consistent with the vulnerability zones previously described in glaucomatous eyes with established VF loss. Ocular hypotensive treatment likely helps to slow the rate of progression in these regions. This suggests that careful monitoring of these locations may be useful.

Blood pressure lowering enhances cerebrospinal fluid efflux to the systemic circulation primarily via the lymphatic vasculature

BackgroundInside the incompressible cranium, the volume of cerebrospinal fluid is directly linked to blood volume: a change in either will induce a compensatory change in the other. Vasodilatory lowering of blood pressure has been shown to result in an increase of intracranial pressure, which, in normal circumstances should return to equilibrium by increased fluid efflux. In this study, we investigated the effect of blood pressure lowering on fluorescent cerebrospinal fluid tracer absorption into the systemic blood circulation.MethodsBlood pressure lowering was performed by an i.v. administration of nitric oxide donor (sodium nitroprusside, 5 µg kg−1 min−1) or the Ca2+-channel blocker (nicardipine hydrochloride, 0.5 µg kg−1 min−1) for 10, and 15 to 40 min, respectively. The effect of blood pressure lowering on cerebrospinal fluid clearance was investigated by measuring the efflux of fluorescent tracers (40 kDa FITC-dextran, 45 kDa Texas Red-conjugated ovalbumin) into blood and deep cervical lymph nodes. The effect of nicardipine on cerebral hemodynamics was investigated by near-infrared spectroscopy. The distribution of cerebrospinal fluid tracers (40 kDa horse radish peroxidase,160 kDa nanogold-conjugated IgG) in exit pathways was also analyzed at an ultrastructural level using electron microscopy.ResultsNicardipine and sodium nitroprusside reduced blood pressure by 32.0 ± 19.6% and 24.0 ± 13.3%, while temporarily elevating intracranial pressure by 14.0 ± 7.0% and 18.2 ± 15.0%, respectively. Blood pressure lowering significantly increased tracer accumulation into dorsal dura, deep cervical lymph nodes and systemic circulation, but reduced perivascular inflow along penetrating arteries in the brain. The enhanced tracer efflux by blood pressure lowering into the systemic circulation was markedly reduced (− 66.7%) by ligation of lymphatic vessels draining into deep cervical lymph nodes.ConclusionsThis is the first study showing that cerebrospinal fluid clearance can be improved with acute hypotensive treatment and that the effect of the treatment is reduced by ligation of a lymphatic drainage pathway. Enhanced cerebrospinal fluid clearance by blood pressure lowering may have therapeutic potential in diseases with dysregulated cerebrospinal fluid flow.

Combined surgery and Preserflo coating with conjunctival graft autologous in acute pseudo‐exfoliative glaucoma

Aims/Purpose: To describe a case of cataract and acute pseudo‐exfoliative glaucoma in which combined surgery with a Preserflo implant was performed and required a conjunctival graft to cover the device due to the friability of the conjunctiva.Methods: A 72‐year‐old male with glaucoma in the left eye (LE) with triple hypotensive treatment, who lost follow‐up due to the pandemic, goes to the emergencies for loss of vision in the LE. A medium dilation, pseudo‐exfoliation and white hypermature cataract can be seen. The intraocular pressure (IOP) is 45 mmHg and does not revert to adequate values with topical and systemic maximum hypotensive treatment. A temporary access cataract surgery is performed without complications. The glaucoma procedure is then performed using the Preserflo implant in the upper nasal area, but the suture produced buttonholes and tears in the conjunctiva that forced us to perform an autologous graft of inferior temporal conjunctiva to cover the implant and ensure a tight closure of the flap.Results: The evolution of AV was favourable. IOP decreased to 10 mmHg and initially at biomicroscopy and Anterior segment optical coherence tomography (AS‐OCT) revealed a diffuse, functioning blister that progressively flattened. The graft was well adhered and positioned. The sclera of the donor area healed by secondary intention. At the 3‐month review, the device was vacuum packed and it was necessary to reintroduce hypotensive eye drops.Conclusions: The Preserflo implant may be less traumatic than other filtering surgeries. The time with hypotensive eye drops contributes to the friability of the conjunctiva and makes us cover the device with an autograft to complete the surgery initially successfully. Although the chronic conjunctival damage may promote fibrosis, disrupt filtration, and require new hypotensive treatment.

Immunonutrition in glaucoma patients: A new microbiota‐based treatment

Glaucoma is one of the main causes of irreversible blindness, producing 12.3% of blindness worldwide. There are about 4.5 million people with glaucoma in the world. However, the real number should be much higher if we consider all people with undiagnosed glaucoma.Glaucoma is an age‐related multifactorial disease determined by both genetic and environmental factors. The cause remains unknown. So, efforts are focused on preventing blindness through early diagnosis and hypotensive treatment, which is not always effective. Currently, neuroprotective treatment is also considered.Among the most studied processes in relation to optic nerve degeneration in glaucoma are inflammation and apoptosis. Several studies show that genes associated with inflammation are upregulated in the trabecular meshwork, which could be related to the onset or progression of glaucoma. However, the most visible manifestations of inflammation in glaucoma occur on the ocular surface. This produces, for example, an infiltration of inflammatory cells and a reduction in corneal sensitivity. Like inflammatory processes, apoptosis has been associated with glaucomatous disease. In fact, vision loss is caused by the death of retinal ganglion cells (RGCs), whose axons form the fibres of the optic nerve. The survival of RGCs is key to the prevention of glaucomatous blindness.The ocular microbiota has recently been studied, analysing the possible association between the inflammatory molecules produced by the ocular microbiome and the etiopathogenic mechanisms of this optic neuropathy.The aim of these studies is the development of probiotics as a therapy for glaucoma. Probiotic strains allow a rapid and stable recovery of the normal ocular microbiota, providing faster anti‐inflammatory and antihistamine effects. In addition, they are antagonists of the pathogens without the risk of the appearance of resistance, which avoids the use of antibiotics. In this way, probiotics represent an alternative to the abusive use of antibiotics, thus avoiding the problem of resistance development. In this sense, polyphenols are very interesting since they are capable of exerting neuroprotective and immunomodulatory effects and also can remodel the microbiota.

Isolated versus combined XEN‐implant surgery

Aims/Purpose: A minimally invasive surgical technique in glaucoma surgery is XEN implant. It allows direct evacuation of aqueous humour from anterior chamber to subconjunctival space. It is indicated in mild or moderate primary open angle glaucoma in patients with treatment with 2 or more active ingredients and good conjunctival status. The objective is to evaluate the effectiveness and safety of XEN implant isolated versus combined cataract surgery.Methods: Single‐centre retrospective observational study, conducted between 2018 and 2023. Follow‐up of 1 year in a sample of 44 eyes operated with XEN implant, 15 with isolated implant and 29 combined surgeries with cataract. Quantitative variables are expressed as mean ± standard deviation. Comparison between variables was performed using Student's t‐test after testing for normality of distribution using the Shapiro–wilk test.Results: Combined cataract surgery with respect to XEN implant placement showed no significant difference in visual acuity improvement, nor in the decrease in post‐surgical hypotensive treatment and intraocular pressure, except in the first month in favour of isolated surgery (p &gt; 0.02). Follow‐up with visual field and optical coherence tomography showed no significant differences, suggesting that there was no progression of glaucoma with both techniques. There were no intraoperative complications. Needling manoeuvre was performed in 60% of patients with isolated XEN compared to 30% with combined surgery. Good safety profile. Other studies find no significant differences in the postoperative success rate between combined surgery or not with phacoemulsification, nor differences in outcomes in phakic versus pseudophakic patients.Conclusions: The XEN implant is effective and safe in terms of IOP lowering and the number of hypotensive drops. There are no significant differences in IOP lowering or in the number of drugs to be administered between the XEN implant alone and combined cataract surgery.

Efficacy and safety of the initial hypotensive treatment with an optimized latanoprost composition

Purpose: a comparative study of the efficacy and safety of Latanoprost-Optic, a new composition of excipients and the original latanoprost, in the initial therapy of primary open-angle glaucoma (POAG)Material and methods. We performed a prospective, randomized, comparative study of 60 previously untreated patients (71 eyes) with early and advanced POAG stages. During the screening visit, patients were randomly divided into the main (Latanoprost-Optic) and the control (original latanoprost) groups. The target points included intraocular pressure (IOP), visual acuity, MD and PSD perimetry indices, RNFL thickness, MRW, NFL, GCL, IPL, tear film break time, OSDI, and adverse events. The observation period was 12 weeks. IOP was measured 4 and 12 weeks from observation start.Results. The average decrease in IOP in the study group by the end of the observation was 32% and did not show any statistically significant differences from the original drug at any control point. A positive unreliable dynamic of the values of most functional parameters was noted, which may indicate the presence of an indirect neuroprotective effect. In the study group, there was a positive trend in tear film rupture time and OSDI. According to corneal confocal microscopy, no negative changes in dynamics were noted, in contrast to the control group. Reversible discomfort and mild redness of the bulbar conjunctiva were recorded in both groups. No serious or systemic adverse events were noted.Conclusion. Latanoprost-Optic has a hypotensive efficacy, comparable to the original latanoprost, and a high favorable safety profile.

Unrecognised autonomic dysreflexia in neurogenic lower urinary tract dysfunction with spinal cord injury as a reason for admission to a cardiac surgical unit

BACKGROUND: In Russia, spinal cord injury occurs in 0.7–6.8% of total injuries. Due to emergence of new rehabilitation protocols, it is extremely important to know the time of occurrence of consequences of spinal cord injury and adequate diagnosis of complications, which allows timely identification of life-threatening conditions of one of the body systems.&#x0D; Clinical case description. We present a clinical case of autonomic dysreflexia in neurogenic lower urinary tract dysfunction after traumatic cervical spinal cord injury in a 17-year-old girl. In traumatic spinal cord injury above the level of the sixth thoracic vertebra, autonomic dysreflexia as a variant of autonomic dysfunction is a common complication. This clinical case will be of interest to clinicians of all specialties who encounter patients with spinal cord injury. It is shown that misinterpreted symptoms of increased blood pressure during bladder filling were the cause of observation and treatment by a cardiologist for arterial hypertension, as well as hospitalization in the cardiac surgery department for planned surgical treatment of renal artery stenosis, which was thought to be the cause of the episodic increases in blood pressure. Lack of knowledge about the presence of autonomic dysfunction in spinal cord injury patients may have led to unnecessary surgical treatment. During the joint management of the patient with a pediatric cardiac surgeon, signs of autonomic dysreflexia were detected against the background of traumatic spinal cord disease at the level of the cervical spine, hypotensive treatment and planned surgical intervention were canceled.&#x0D; Conclusion. Subsequently, an adequate regimen of periodic bladder catheterization and antimuscarinic drug therapy was prescribed, which successfully reduced the dysreflexia.

Efficiency and safety of the fixed latanoprost/ dorzolamide combination in open-angle glaucoma hypotensive treatment

Purpose: to determine the efficacy and safety of fixed latanoprost/dorzolamide combination Dorzoprost in hypotensive treatment of primary open-angle glaucoma (POAG) patients previously treated with latanoprost.Material and methods. An observational study included 30 patients (37 eyes) with moderate and advanced POAG who had uncompensated elevated IOP receiving latanoprost monotherapy. During the screening visit, latanoprost was switched to Dorzoprost instilled once in the evening. The targets were IOP, visual acuity, MD and PSD perimetry indices, retinal nerve fiber layer thickness, minimum width of the neuroretinal rim, macula retinal nerve fiber layer thickness, and adverse events. The observation period lasted 12 weeks. IOP was measured at weeks 4 and 12.Results. After 4 weeks, a statistically significant decrease in IOP was noted, which remained stable at 12 weeks. The average additional IOP decrease of those treated with Dorzoprost was 17%. Statistically insignificant positive changes were registered in visual acuity, static perimetry and optical coherence tomography. By the end of the observation period, 6 cases revealed a decrease in the degree of conjunctival hyperemia, while all dry eye syndrome cases (5 patients) showed a decrease in the severity of the signs of the syndrome.Conclusion. Dorzoprost has a significant additive hypotensive effect and a favorable safety profile.

Logistic regression model for predicting failure of dual antihypertensive therapy: a prospective comparative non-randomized clinical trial

Background. Initial dual antihypertensive therapy is currently considered as the first management step for the majority of patients with arterial hypertension. However, it often fails to achieve the target blood pressure levels. An approved algorithm for predicting the failure of dual antihypertensive therapy is still to be developed. Objectives. To establish predictors of dual antihypertensive therapy failure in patients with high and very high cardiovascular risk and to create a model for predicting negative outcome of dual antihypertensive therapy. Methods. The paper presents a prospective comparative non-randomized clinical trial. The recruiting of participants and recording of results were carried out in March–December 2019 with 3 months of the follow-up period. The trial involved examination of 88 patients with poor blood pressure control, stage II and III arterial hypertension, high and very high cardiovascular risk of stages 1–3. Clinical and laboratory examination was carried out in compliance with the current regulatory documents. Additional examination included tests for uric acid, high-sensitivity C-reactive protein, as well as respiratory polygraphy and computerized capillaroscopy. All patients were prescribed dual antihypertensive therapy. The primary search for predictors was performed using the binary logistic regression. The predictive model was developed by stepwise variable selection. The diagnostic significance of the binary classifier was assessed by means of ROC-curve analysis; the calculation was performed using MedCalc 20.218 software (MedCalc Software Ltd., Belgium). Results. Administration of two hypotensive drugs appears to be effective in 33% of patients. The final model for predicting negative outcomes of dual antihypertensive therapy included such independent predictors as interventricular septal thickness, daily mean systolic blood pressure, and area density of the capillary network. The odds ratio accounted for 9.1 (95% confidence interval 3.12; 26.82). The area under the ROC curve based on the multiple binary logistic regression model comprised 0.805±0.05 with 95% confidence interval: 0.707-0.882 (p&lt;0.0001). The sensitivity and specificity of the method amounted to 83.1 and 69.0%, respectively. The prediction accuracy comprised 77.3%. Conclusion. The development of patient-oriented algorithms for selection of hypotensive treatment is considered to be essential due to poor blood pressure control during dual antihypertensive therapy. The developed prognostic model may be applied when managing hypertension.

Prevalence and clinical characteristics of uveitic glaucoma: multicentric study in Bogotá, Colombia

ObjectivesTo describe the clinical features of patients diagnosed with uveitic glaucoma (UG) and ocular hypertension secondary to uveitis (OHT-SU).MethodsA multicentric cross-sectional study using medical records of patients with uveitis between 2013 and 2021. Uveitis and glaucoma specialists examined all patients. Variables were analyzed using the chi-square or Fisher’s exact test for categorical variables. Additionally, t test, Mann–Whitney, and Kruskal–Wallis variance analysis were used for continuous variables. Finally, a Kaplan–Meier survival analysis for UG and OHT-SU development over time was done.ResultsOf the 660 clinical records reviewed of patients with uveitis, 191 (28.9%) had OHT-SU in at least one visit, and 108 (16.4%) of them developed UG. In all ages, females were more affected than males. Anterior uveitis was the main anatomic localisation, and non-granulomatous, recurrent, and inactive uveitis were the most frequent clinical features. The mean final visual acuity was 0.3 (0.0–1.0) LogMAR. Also, 95.8% of the patients had additional sequelae related to uveitis regardless of UG and OHT-SU. Interestingly, males had earlier affection, with statistical significance in OHT for adults (P = 0.036) and UG for children (P = 0.04). Of all patients, 81.1% received topical hypotensive treatment and 29.8% required a surgical procedure.ConclusionsUG and OHT-SU are common complications of uveitis in the Colombian population. These sight-threatening conditions were more common and appeared sooner in men at any age. Our results suggest that earlier and more aggressive treatment with topical hypotensive agents could positively influence the visual outcomes and the requirement of surgical procedures.

Improvement of objective ocular redness measured with Keratograph 5M in glaucoma patients after instilling brimonidine drops.

To compare objective ocular redness measured using OCULUS Keratograph 5 M before and after 0.2% brimonidine instillation in glaucoma patients under topical hypotensive treatment. 60 eyes from 60 subjects diagnosed with glaucoma or ocular hypertension under hypotensive ocular topical treatment were analyzed. Basal Ophthalmological examination was performed.Outcome variables were OCULUS Keratograph 5 M redness scores (RS) before and after 0.2% brimonidine instillation; overall, bulbar temporal (BT), bulbar nasal (BN), limbar temporal (LT), and limbar nasal (LN); non-invasive average tear film breakup time (Nia-BUT), non-invasive first tear film breakup time (Nif-BUT) and meibography. In addition, the following clinical data were collected: intraocular pressure, type, duration, amount, and preservatives/or not of hypotensive treatment, fluorescein corneal staining score and lower tear meniscus height. All eyes were under topical medication. All redness scores were reduced after brimonidine instillation, mean RS differences were BT 0.82 ± 0.62, BN hyperemia 1.03 ± 0.55, LN hyperemia 0.84 ± 0.49, LT hyperemia 0.71 ± 0.50 and total hyperemia 0.91 ± 0.52 (all p < 0.001). 30 min after brimonidine instillation mean overall RS reduction was 47.97 ± 12.39% (p < 0.001) and after 1 h there was a persistent reduction of overall RS of 45.92 ± 14.27% (p < 0.001). Hyperemia reduction was significant and comparable between preservative and preservative-free group 0.12 ± 0.14 (p > 0.392) and between patient with combination therapy and monotherapy 0.16 ± 0.14 (p > 0.258). A significant reduction of conjunctival hyperemia was objectively found in glaucoma patients under topical hypotensive treatment before and after brimonidine instillation. Its fast and long-lasting effect may be useful preoperatively in glaucoma patients to reduce intraoperative bleeding and associated complications.

Perspectives on Adherence to Glaucoma Medical Therapy in Brazilian Patients.

Poor adherence to glaucoma medication regimens may be associated with subsequent optic nerve damage and irreversible visual loss. Specific barriers to effective patient adherence in low-middle income countries are not fully recognized and new disease-specific instruments to assess adherence have been developed. The purpose of this cross-sectional study was to evaluate adherence of primary open-angle glaucoma (POAG) patients to treatment in a middle-income country. POAG patients were recruited from the Glaucoma Service - Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil. Clinical and demographic data were retrieved from participants' electronic records. All patients answered the Glaucoma Treatment Compliance Assessment Tool (GTCAT). This 27-item questionnaire was designed to evaluate multiple behavioral factors associated with glaucoma medication adherence. The sample comprised 96 patients with POAG. The mean age was 63.2 ± 8.9 years; 48 were male and 48 female; 55 (57.3%) were White, 36 (37.5%) African-Brazilian, and five (5.2 %) were of mixed color. Most patients (97.9%) had less than a high school degree and all had a family income <US$10,000. The GTCAT identified 69 (71.8%) patients who "sometimes forget to use drops," 68 (70.8%) patients who "sometimes fall asleep before dosing time," and 60 (62.5%) patients "whose drops aren't with them at the time to take them"; 82 (85.4%) patients admitted to using "reminders to take medications." Eighty-two (85.4%) patients agreed that "doctor answers my questions," and 77 (80.5%) said "they are happy with their eye doctor." The GTCAT identified a number of mostly unintentional factors associated with adherence in this cohort of Brazilian patients. The data may impact on how to understand and improve adherence to ocular hypotensive treatment in the Brazilian population.

FROM A SYNCOPE TO MYOCARDITIS - AN UNUSUAL MANIFESTATION OF MYOCARDITIS IN OBESE PATIENT WITH HYPERTENSION AND PARANOIDAL SCHIZOPHRENIA

Objective: The case report presents a 30-year-old obese patient with a history of paranoidal schizophrenia, sinus tachycardia and hypertension which was admitted to the Department of Internal Medicine and Hypertension after fainting the day before. In the admission the patient suffers from a chest pain, dizziness, and abdominal pain. The physical examination revealed: BP 161/104mmHg, HR 120/min, SatO2 94%, overdeveloped fatty tissue and pain in the left chest and abdominal area after a collapse. Laboratory tests showed increased inflammation and cardiac parameters as well as extremely high concentration of TCAs (Tricyclic antidepressants). The ECG and ECHO were carried out, the former showed ST elevations in ECG leads II, III, aVF, V4-V6, the latter reveled dilation of the right ventricle, left ventricular hypertrophy and lower ejection fraction, EF = 48%. Hypotensive treatment was implemented resulting lowering blood pressure. However, the patient's condition did not get better. Stabbing and burning chest pain persisted. Considering a clinical picture, contrast-MRI was performed showing LGE (late gadolinium enhancement) on the lateral-inferior part of the left ventricle wall characteristic for myocarditis (MC). The objective of this case report is to highlight a possibility of myocarditis when there are symptoms responding to other heart diseases, atypical for MC and the role of detailed diagnostic process and holistic perspective. Design and method: Case report presentation of the patient admitted to the hospital due to the collapse episode the day before. Symptoms and additional test analysis and making the final diagnosis. Results: Initial diagnostic tests were negative or inconclusive until heart contrast-MRI was performed revealing - LGE foci in the left ventricle wall corresponding to the area of inflammatory lesion of the lateral-inferior part of the left ventricle wall. Conclusions: Although, myocarditis is a rare finding, more frequent in younger population, it is associated with significant complications and mortality thus early diagnosis can prevent critical condition. In presented case, the difficulty in making a final diagnosis of myocarditis was affected by predominant cardiac attack symptoms. Moreover, MC could be caused by TCA which high concentration was found in the patient's blood.

EVALUATION ON CLINICAL APPLICATION OF LOW-DOSE TRADITIONAL QUADRUPLE ANTIHYPERTENSIVE COMPOUND PREPARATION IN CHINA

Objective: To evaluate whether a relatively old multi-drug SPC prescription can be adapted to current treatments of hypertension. Design and method: 1. In a retrospective, real-world study, 22148 patients with hypertension who visited 4 hospitals in China from 2011 to May 2016 were selected as the subjects. A comparison was conducted between treatment with compound reserpine and triamterene tablets (Reserpine/Triamterene CAS) and with four other single-pill combinations (SPCs) (losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide, and amlodipine/valsartan) for 20 days. The compliance rate was analyzed after patients’ propensity score matching analysis. 2. A meta-analysis of 7 randomized controlled trials on the safety and efficacy of compound reserpine and triamterene tablets published from 2000 to 2020 was conducted. Results: 1. Treatment with 1 compound reserpine and triamterene tablet daily (R/L) resulted in a blood pressure compliance rate (BP &lt; 140/90 mmHg) of 63 to 68%. Compared with valsartan/amlodipine, R/L achieved a compliance rate of 63% vs 50%; with valsartan/hydrochlorothiazide, of 64% vs 59%; with losartan/hydrochlorothiazide, of 67% vs 57%, and with irbesartan/hydrochlorothiazide, of 68% vs 59%. All P values were &lt; 0.05 (Figure 1). 2. Seven studies were included in the meta-analysis. In five studies, the overall response rate of hypotensive treatment with compound reserpine and triamterene tablets was higher in efficacy study compared with other hypotensive drugs (OR = 2.23, 95% CI: 1.32 ∼ 3.75) (Figure 2), and there was no significant difference in the incidence of adverse reaction with compound reserpine and triamterene tablets in the 6 trials included in the safety study (OR = 0.91, 95% CI: 0.68 ∼ 1.22) (Figure 3). Conclusions: China is faced with high prevalence of hypertension, low control rate, and scarce medical resources and economic resources in primary medical care, but ultra-low-dose SPC (R/L) can improve the antihypertensive effect and reduce the incidence of adverse reactions (Figure 4) through the synergistic effect among different components of the drug and has good patients’ compliance and low price. We confirmed that through systematic review and meta-analysis, ultra-low-dose SPC (R/L) is suitable for the treatment of hypertension, especially those with refractory hypertension.

Renal hemodynamics in patients with arterial hypertension. (Literature review)

Despite the obvious progress, the diversification of therapeutic possibilities and countless studies, hypertension is still often difficult to control. Unfortunately, the frequency of cases in which blood pressure does not reach the guideline targets is very high globally. The challenging concept of resistant hypertension represents a difficult situation in the practical approach. Being simultaneously a disease and a reducible risk factor for major cardiovascular events, we can point out that the correct approach to resistant hypertension marks one of the major goals in cardiology. Recent studies highlight the importance of the renal hemodynamics of the hypertensive patient with possible assessment of the evolution over time of renal function, target organ damage and the response to hypotensive treatment. Thus, both from a scientific point of view and for practical medicine, the identification of the peculiarities of renal hemodynamics in hypertensive patients resistant to treatment is of particular interest