Incidence Of Ocular Side Effects Research Articles

Real-Life Study on the Efficacy and Tolerance of a Preservative-Free Surfactant-Free Latanoprost Eye Drop in Patients with Glaucoma.

The purpose of this study is to assess the real-life efficacy and tolerance of a new preservative-free, surfactant-free latanoprost (PFSF-LAT) formulation. Retrospective, multicentre, non-comparative, observational study in patients with ocular hypertension or open angle glaucoma, naïve or non-naïve to previous intraocular pressure (IOP)-lowering treatment, and treated for at least 3months with the study eye drop. IOP for worse eye, ocular signs and symptoms, and concomitant use of artificial tears were collected at study drug initiation and at last visit under treatment. Reasons for discontinuing the study eye drop (if relevant) and investigators' satisfaction were also assessed. In the per protocol population (103 eyes; 63 naïve, 39 switched, 1 not classified because of missing data), IOP decreased significantly (p < 0.001) from 21.6 ± 5.0mmHg at baseline to 16.1 ± 3.5mmHg at the end of the study (mean reduction of - 5.5 ± 4.6mmHg; - 25.5%). IOP in naïve patients was significantly improved, with a mean reduction of 7.1mmHg (- 30.7%), which was within expected latanoprost IOP-lowering effect. Interestingly, in previously treated patients, switching to PFSF-LAT also allowed for a further 2.9mmHg decrease in IOP (p < 0.001). The incidence of ocular side effects at study initiation was significantly (p < 0.001) reduced from 31.1% to 11.3% in the overall population, and from 65.0% to 7.5% in switched patients. This included conjunctival hyperaemia and superficial punctate keratitis (from 42.5% to 2.5% and from 37.5% to 2.5% in switched patients, respectively). According to investigators, tolerance and efficacy of the study eye drop were satisfactory or very satisfactory in 98.1% and 83.2% of patients, respectively. PFSF-LAT is an efficient treatment for patients with glaucoma with an improved tolerance profile. It can be considered as initial therapy in naïve patients or in patients with poor ocular tolerance to previous IOP-lowering eye drops.

A TRANSDISCIPLINARY APPROACH TO THE TREATMENT OF DRY EYE DISEASE IN PATIENTS WITH PSYCHIATRIC DISORDERS

IntroductionDry eye disease (DED) is a multifactorial disease of the tear film and ocular surface representing one of the most common problems in ophthalmological practice and significant public health problem. Characteristic symptoms of DED include gritty, sandy foreign body sensation as well as visual disturbances that have a negative impact on the patient’s daily activities and also affecting patient’s quality of life (QOL).ObjectivesThe objective of this research is to point out the importance of transdisciplinary approach to treatment of dry eye disease in patients with psychiatric disorders.MethodsWe reviewed all current available literature in Pubmed dealing with the topic of connection of dry eye disease and psychiatric disorders.ResultsIn recent years, the relationship between DED and psychiatric disorders has been gaining attention. A number of epidemiological studies have reported a possible association between dry eye and psychiatric disorders showing that the subjective symptoms of dry eye can be affected not only by changes of the tear film and ocular surface but also psychological factors such as anxiety, depression, schizophrenia, post-traumatic stress disorder (PTSP) and subjective happiness. Apart from psychiatric disorders, psychiatric medications are also considered as risk factors for DED due to their influence on the tear film status. The incidence of ocular side effects increases rapidly with the use of polypharmacy, a very common form of treatment used in psychiatry.Mental health disorders may be one of considerable contributing factors for dry eye symptoms and undiagnosed mental health conditions can be an influencing element for unexplained levels of DED symptoms. Depression, anxiety, stress, hypochondriasis, neuroticism, sleep and mood disorders may be associated with the exacerbation of symptoms to degrees that are not consistent with the objective signs related to tear dysfunction as well as changes in the anterior surface of the eye.There is often inconsistency between signs and symptoms of DED, where symptoms often are more related to non-ocular conditions including psychiatric disorders than to tear film parameters. Consequently, in many cases DED may be considered as a psychiatric as well as ophthalmological problem. Psychiatrists and ophthalmologists need to be aware of the potential influence of psychiatric disorders and medications on tear film stability.ConclusionsA detailed medical history, thorough ophthalmological examination and referral to a psychologist or psychiatrist may be essential in the treatment of those patients. In treatment of psychiatric patients, an integrative and transdisciplinary approach will result in better functioning and higher QOL.Disclosure of InterestNone Declared

Adverse ocular effects of neuroleptic therapy: semiotics, pathogenesis and treatment

Antipsychotics are widely used in psychiatric practice for treating schizophrenia, bipolar disorder, and other diseases, including those treated off-label. They manifest many adverse effects, including ophthalmic ones. Some of these effects, such as persistent mydriasis, cycloplegia, extraocular muscle dystonia, and visual hypersensitivity attacks are reversible, since they disappear after dose reduction or drug withdrawal. Yet other side effects, such as cataracts, corneal edema, acute angle closure glaucoma and retinopathy are threatening for sight and may lead to permanent visual acuity decline and even blindness. The review provides data on the incidence of ocular side effects (both typical and atypical) of multiple antipsychotics, their clinical manifestations, pathogenesis and treatment. Eye examination is recommended for patients taking antipsychotics in the early periods of treatment and then twice a year. The psychiatrists need to know about the adverse effects of individual drugs whilst the ophthalmologists should be aware of their semiotics, pathogenesis and treatment, since timely diagnosis and treatment of pathological changes, together with antipsychotic therapy modification, prevent the development of severe and irreversible visual impairment in the majority of cases.

Selective laser trabeculoplasty versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials

BackgroundThe only widely accepted, effective treatment for open-angle glaucoma (OAG) is to reduce the intraocular pressure (IOP), with medical therapy being the typical first-line therapy. Notably, an alternative therapy is...

Statin-associated ocular disorders: the FDA and ADRAC data.

Statins are a class of medication indicated for atherosclerotic diseases and dyslipidemia. Since their appearance, many adverse events have been associated with their use. Ocular disorders are rare but serious adverse events of statins. To report the association between statins and ocular adverse events (blurred vision, visual impairment, visual field defect, reduced visual acuity, myopia, hypermetropia, presbyopia, and astigmatism) which might be associated with muscle or liver problems by examining the frequency of ocular adverse events among the reported adverse drug reactions from the Food and Drug Administration (FDA) and Adverse Drug Reactions Advisory Committee (ADRAC) data. Setting The FDA USA and ADRAC Australia databases. We conducted a retrospective study of statin-associated ocular adverse events reported to FDA between 1988 and 2013 and ADRAC between 1988 and 2011. The recoded data included: patient's age, gender, suspected drug and dosage, concomitant drug, adverse events, duration of therapy, dechallenge and rechallenge therapy. The differences in the adverse events profiles between each of the statins and atorvastatin were performed using Chi square and multivariate (logistic regression) statistical tests. Percentages of subjects correlated with each Ocular adverse events. Among 131,755 cases of patients taking statins in the FDA, there were 2325 cases reported ocular adverse events after using statins (1.8%). The Chi square statistic showed that the proportions of ocular adverse events varied significantly (p < 0.0001) across the different statin drugs. The most highly reported ocular adverse events associated with statins were blurred vision (48.4%) and visual impairment (25.7%). Results from logistic regression indicated that the ocular problems formed a greater proportion of the adverse events for subjects taking atorvastatin (2.1%). Of the 1.8%, ocular adverse events mostly occurred alone (60.9%), followed by 30.3% where muscle adverse events also were involved. The ADRAC data held 136 cases of statins associated ocular adverse events (47 patients reported blurred vision and 64 reported vision impairment). All statins were associated with ocular side effects, with atorvastatin showed a higher incidence of ocular side effects in conjunction with muscle and liver problems.

Incidence of ocular side effects with intravenous zoledronate: secondary analysis of a randomized controlled trial.

This prospective study showed that the incidence of acute anterior uveitis, confirmed by ophthalmic examination, in patients receiving intravenous zoledronate infusions as part of a randomized controlled trial for fracture prevention is 1.1%. We prospectively investigated the incidence of ocular side effects after a single intravenous zoledronate infusion. In a secondary analysis of a double-blind, placebo-controlled trial in which early post-menopausal women (N=1054) with normal bone density or osteopenia were randomized to infusion of zoledronate 5 mg (N=703) or placebo (N=351), we analyzed significant adverse ocular events occurring within 3 months. Fourteen participants reported ocular symptoms after the infusion. All were examined by an ophthalmologist and eight were diagnosed with acute anterior uveitis (AAU) and one with sectoral episcleritis. The incidence of AAU and episcleritis was 1.1% (95% CI 0.5-2.1) and 0.1% (95% CI 0.0-0.7), respectively, in the zoledronate group and 0% for both conditions in the placebo group (95% CI 0.0-0.8). The mean time from infusion to symptom onset for AAU was 3 days (range 2-4). Three cases were bilateral. AAU was mild-moderate in seven participants and severe in one. All affected eyes were treated with topical cyclopentolate 1% (to break, or minimize, posterior synechiae), and intensive, potent, topical corticosteroids with a tapering regime based on treatment response. The mean duration of topical corticosteroid was 26±10 days (range 17-44). The mean, best corrected visual acuity was 20/20 (range 20/20-20/40) at presentation, which remained unchanged after AAU resolution. None of the participants lost vision, and no long-term sequelae were reported at last follow-up (range 3-13 months post-infusion). Prescribers should inform patients about the possibility of ocular side effects with zoledronate infusions and refer promptly to an ophthalmologist if symptoms develop.

Radiation complications and tumor control after 125I plaque brachytherapy for ocular melanoma

To determine the outcome of 125I plaque brachytherapy at our institution and identify the risk factors associated with the development of radiation complications, tumor recurrence, and metastasis. From 1986 to 2000, 156 patients underwent 125I episcleral plaque (COMS design) application for the treatment of ocular melanoma. Chart analysis of follow-up ophthalmologic appointments assessed the incidence of ocular side effects after therapy. Statistical analysis assessed outcomes and significant influencing factors. With a median follow-up of 6.2 years, the 5-year overall survival was 83%. The 5-year disease-specific survival was 91%. Initial local control at 5 years was 92%, with 100% ultimate local control after secondary therapy that included 9 enucleations. The risk of metastasis was 10% at 5 years and 27% at 10 years. Vision stayed the same or improved in 25% of patients, and 44% of patients maintained visual acuity better than 20/200. Thirteen percent of patients experienced chronic pain or discomfort in the treated eye. Dose rates to the tumor apex greater than 90 to 100 cGy/h were associated with increased systemic control but worse radiation toxicity. Patients in our series experienced excellent local tumor control. Higher dose rates to the tumor apex were associated with reduced rates of distant metastases but worse ocular function.

A Comparison of Intraocular Pressure-Lowering Effect of Prostaglandin F2-?? Analogues, Latanoprost, and Unoprostone Isopropyl

To compare the intraocular pressure-lowering effect of unoprostone isopropyl (unoprostone) 0.12% and latanoprost 0.005%. A correlation between the intraocular pressure-lowering effect of unoprostone and latanoprost was also evaluated. A single-masked randomized study included 18 patients between 49 and 68 years (mean, 60.7 +/- 5.1 years) with an intraocular pressure of both eyes from 21 to 27 mm Hg. The patients were prospectively randomized to receive latanoprost in the right eye and unoprostone in the left eye, or unoprostone in the right eye and latanoprost in the left eye. The patients were followed up for 8 weeks. This study evaluated the intraocular pressure-lowering effect and incidence of drug-related side effects. Mean baseline intraocular pressure was 22.8 +/- 1.2 mm Hg in latanoprost-treated eyes and 22.4 +/- 1.0 mm Hg in unoprostone-treated eyes; there was no statistically significant difference between these groups. Mean intraocular pressure at 8 weeks after the start of the administration was 16.7 +/- 2.0 mm Hg in latanoprost-treated eyes and 19.0 +/- 1.5 mm Hg in unoprostone-treated eyes. Patients in the latanoprost-treated group showed a greater intraocular pressure reduction compared with those in the unoprostone-treated group. Mean intraocular pressure changes in latanoprost-treated eyes were significantly greater at every visit (P < 0.0001). A change of intraocular pressure at 8 weeks in the latanoprost-treated eyes was significantly correlated with that in the contralateral unoprostone-treated eyes (r = 0.665, P = 0.0013) (Figure). There was no significant difference in the rate of ocular side effects between latanoprost- and unoprostone-treated eyes. Latanoprost appears to have a more beneficial effect for intraocular pressure control compared with unoprostone. An intraocular pressure reduction in the latanoprost-treated eyes was significantly correlated with that in the contralateral unoprostone-treated eyes. There was no significant difference in the incidence of ocular side effects between both drugs. Further investigation using more cases and longer follow-up periods are needed.

Lacrimal Duct Stenosis and Other Ocular Toxicity Associated with Adjuvant Cyclophosphamide, Methotrexate and 5-Fluorouracil Combination Chemotherapy for Early Stage Breast Cancer

Certain side-effects of chemotherapy are well recognized but ocular toxicity is often underestimated. This retrospective study was undertaken after we became aware of a case of irreversible lacrimal duct stenosis in a woman receiving adjuvant chemotherapy for early stage breast cancer. Using the chemotherapy records, 128 patients who received adjuvant cyclophosphamide, methotrexate and 5-fluorouracil combination chemotherapy for early stage breast cancer over a 212-year period were identified. The case notes of these patients were reviewed and an 18% incidence of ocular side-effects, including four other cases of epiphora, was identified. The epiphora resolved fully on completion of chemotherapy in these four patients but not in the index patient. The optimal management of these side-effects is unclear but it needs to be tailored to the particular toxicity experienced by the patient.

Incidence of ocular side effects of topical β blockers in the Netherlands

BACKGROUNDSeveral ocular side effects including uveitis, have been reported following topical β blocker treatment for glaucoma and ocular hypertension. The incidence of these side effects was investigated in the Netherlands.METHODSA...