Intraocular Pressure Lowering Effect Research Articles

Lipid-Gelucire based rectal delivery of ramipril prodrug exhibits significant lowering of intra-ocular pressure in normotensive rabbit: Sustained structural relaxation release kinetics and IVIVC

ABSTRACT: Carboxylesterase enzymes convert a prodrug ramipril into the biologically active metabolite ramiprilat. It is prescribed for controlling ocular hypertension after oral administration. High concentrations of carboxylesterase enzymes in rectal and colon tissue can transform ramipril significantly to ramiprilat. Sustained rectal delivery of ramipril has been developed for intra-ocular pressure lowering effect using a normotensive rabbit model. Rectal suppositories have been formulated using a matrix base of HPMC K100-PEG 400-PEG 6000, incorporating varying amounts of Gelucire by the fusion moulding method. The presence of Gelucire in the suppository exhibited sustained structural relaxation-based release kinetics of RM compared to its absence. Intravenous and oral administration of ramipril has decreased IOP in the treated rabbit up to 90 and 360 min, respectively. Treated rabbits with suppositories have revealed decreased IOP for an extended period compared to the above. Formulation containing GEL 3% reduced intra-ocular pressure to 540 min, with the highest area under the decreased IOP curve. Compared to oral, the pharmacodynamic bioavailability of ramipril has been improved significantly using a sustained-release rectal suppository. A rectal suppository for sustained delivery of ramipril could be used to lower IOP significantly.

Prostaglandin analogs regimen for open-angle glaucoma or hypertensive ocular, is it still effective nowadays?: a systematic review

Introduction & Objectives : Open-angle glaucoma and hypertensive ocular therapy are still developing. There are new medications that offer fast and safe in lowering intraocular pressure. Prostaglandin analogs regimenis a well-known medication that we use in lowering intraocular pressure and still use in this era.
 Methods : A literature search was performed in PubMed, Chocraine, and Google Scholar for studies that fit our inclusion criteria. The Literature must be Randomized controlled trials, Systematic reviews, and meta-analyses from 2013 until 2023 that report data on prostaglandin analogs regimen uses medications for open-angle glaucoma or ocular hypertension. That consists of data on intraocular pressure (IOP) lowering effect by the use of prostaglandin analogs regimen monotherapy or combination.
 Results : We included Ten literature that consists 5 RCTs (1514 participants), and 5 systematic reviews with meta-analysis (235 RCT literature), that overall make intraocular pressure (IOP) reduction. There are differences in duration to reduce IOP between prostaglandin analogs regimen types and combinations with other classes of regimen.
 Conclusion : prostaglandin analogs regimen effective in IOP lowering effect in open-angle glaucoma and hypertensive ocular both monotherapy and combination.

Prostaglandin analogs regimen for open-angle glaucoma or hypertensive ocular, is it still effective nowadays?: a systematic review

Introduction & Objectives : Open-angle glaucoma and hypertensive ocular therapy are still developing. There are new medications that offer fast and safe in lowering intraocular pressure. Prostaglandin analogs regimenis a well-known medication that we use in lowering intraocular pressure and still use in this era.
 Methods : A literature search was performed in PubMed, Chocraine, and Google Scholar for studies that fit our inclusion criteria. The Literature must be Randomized controlled trials, Systematic reviews, and meta-analyses from 2013 until 2023 that report data on prostaglandin analogs regimen uses medications for open-angle glaucoma or ocular hypertension. That consists of data on intraocular pressure (IOP) lowering effect by the use of prostaglandin analogs regimen monotherapy or combination.
 Results : We included Ten literature that consists 5 RCTs (1514 participants), and 5 systematic reviews with meta-analysis (235 RCT literature), that overall make intraocular pressure (IOP) reduction. There are differences in duration to reduce IOP between prostaglandin analogs regimen types and combinations with other classes of regimen.
 Conclusion : prostaglandin analogs regimen effective in IOP lowering effect in open-angle glaucoma and hypertensive ocular both monotherapy and combination.

Ab-Interno Bleb Needling in A Failed Trabeculectomy: A Case Report

Introduction : Trabeculectomy remains a gold standard of glaucoma surgical management despite a steady rate of bleb failure due to conjunctival scarring. In this case, we report a case of a failed trabeculectomy managed with ab-interno bleb needling followed by antimetabolite injection of mitomycin C.
 Case Illustration : A 18-year-old male patient with a history of blurry vision in his right eye and vision loss in his left eye. The patient had previously undergone cataract surgery due to juvenile cataracts and developed persistent high intraocular pressure (IOP) in both of his eyes. A trabeculectomy was performed on his right eye six months prior to the examination; however, the IOP remained at 22 mmHg. Ocular examination revealed a shallow anterior chamber and flat conjunctival bleb. An ab-interno bleb needling technique was performed followed by antimetabolite injection of mitomycin C under local anesthesia in an operating theatre. Follow-up results showed a significant reduction of IOP on the first day (13.3 mmHg) and a week after surgery (18.5 mmHg), maintained by one anti-glaucoma eye drop.
 Discussion : Trabeculectomy filtration surgery has a high failure rate in younger patients due to a high risk of conjunctival scarring. The ab-interno needling approach with mitomycin C injection is a novel technique that can be performed and offers the advantage of increasing aqueous outflow through a direct opening of the trabecular meshwork from within the anterior chamber.
 Conclusion : This technique provides effective management of failed trabeculectomy to achieve intraocular pressure lowering effect and a corresponding decrease in the risk of progressive glaucomatous optic neuropathy.

Microinvasive Glaucoma Surgery using Goniotomy as A Potential Surgical Treatment Modality in Indonesia: A Descriptive Study and Literature Review

Introduction & ObjectivesMicro-invasive glaucoma surgery with goniotomy is a recent surgical treatment modality that targetsthe trabecular outflow to maintain intraocular pressure. This study aims to describe the clinicaloutcomes of excisional goniotomy using KDB and to review the published literature regarding amodified goniotomy technique as a potential surgical treatment modality in Indonesia.
 MethodsA cross-sectional descriptive study was conducted in patients that underwent goniotomy stand-aloneor combined with cataract surgery. Main outcome parameters consist of visual acuity, intraocularpressure (IOP), number of glaucoma medications, and complications during post-operative follow-up.
 ResultsA total of 7 patients (8 eyes) were included in the study, consisting of 5 (71,4%) males and 2 (28,6%)females. The mean age of the subjects was 47.7 years. Subjects consisted of primary,pseudoexfoliative, steroid-induced, and angle-recess glaucoma. Mean pre-operative IOPmeasurements showed 20.74 mmHg with visual acuity consisting of 1 (14.3%) mild visualimpairment and 7 (85.7%) severe visual impairment. Postoperatively there was progressiveimprovement in the mean IOP to 13.81 and 11.31 mmHg on first-day and one-week follow-up,respectively. Visual improvement was observed in 2 (28.5%) with mild visual impairment, 3 (42.6%)with severe visual impairment, and 2 (28.5%) with hand movement due to complications of cornealedema following phacoemulsification. A week later, visual acuity improved to 4 (57.1%) with mildvisual impairment and 3 (42.9%) with moderate visual impairment.
 ConclusionGoniotomy is a simple surgical method that may be applied in Indonesia as a novel technique toprovide an effective intraocular pressure-lowering effect.

SELECTIVE LASER TRABECULOPLASTY AS A VALUEABLE MODALITY OF TREATMENT IN OPEN ANGLE GLAUCOMA PATIENT

Introduction & ObjectivesSelective Laser Trabeculoplasty (SLT) has became an established treatment to lower intraocularpressure (IOP) for open angle glaucoma (OAG) and ocular hypertension. The aim of this study was toevaluate IOP lowering effect of SLT and correlate its laser parameter to the successful rate in OAG.
 MethodsThis is a prospective study of seventeen eyes OAG patients in Cicendo Eye Hospital from 1stNovember 2022 to 31th December 2022. SLT performed once in OAG with uncontrolled IOP (IOP >21 mmHg). Outcome measured were IOP at post laser, 1week , 1 month, and 2 months of follow upafter SLT. Successful criteria determined as greater than 20% IOP reduction. Correlation betweensetting operational of SLT and primary outcome were measured. Student’s t-test (two-tailed,dependent) has been used to find the significance of study parameters.
 ResultsA total 17 eyes underwent SLT. Mean baseline IOP was 21,12 ? 4,0 mmHg. IOP was significantlydecreased from baseline post laser 18,06 ? 3,17 mmHg; at 1 week 17,06 ? 3,25 mmHg; 1 month15,53 ? 4,52 mmHg; and at 2 month follow up 15,47 ? 4,02 mmHg (p<0,001). The successful rate ofSLT after two months follow up from this study were 76,5% samples (13 eyes). Mean of total laserenergy was 75,6 ? 16,8 mJ. There was correlation between total laser energy with percentage of 1month IOP reduction (coefficient : 0,470 (p<0,029)).
 ConclusionSLT is effective and safe for reducing IOP in open angle glaucoma patient.

Glaucoma surgical procedure choice in vulnerable corneal endothelium

This talk will focus on the decision making in patients with vulnerable corneal endothelium requiring glaucoma surgical intervention. The effect of glaucoma surgical procedures on corneal endothelium will be briefly analysed and conditions with vulnerable corneal endothelium and co‐existent intraocular pressure (IOP) elevation, such as Fuchs corneal endothelial dystrophy with primary open angle glaucoma or post‐keratoplasty steroid response, will be adequately described. The aim of the talk is to indicate the most appropriate glaucoma surgical interventions depending on the status of corneal endothelium and the desired IOP lowering effect, covering a wide spectrum of surgical procedures including minimally invasive interventions, such as Preserflow implantation, as well as ab interno/ab externo viscocanaloplasty or conventional procedures such as trabeculectomy or big tube implantation. Finally, the talk will highlight useful surgical tips for the abovementioned surgical procedures, and it will provide suggestions for patient selection in order to optimize clinical outcomes.

Intraocular pressure-lowering effects of ripasudil on open-angle glaucoma in eyes with high myopia and pathological myopia

The aim is to study the intraocular pressure (IOP)-lowering effects of additional administration of ripasudil in open-angle glaucoma (OAG) patients including high myopia (HM) and pathological myopia (PM). Study design is retrospective cohort study. We assessed the changes in the mean IOP between the HM eyes (axial length ≧ 26.5 mm 33 eyes) and the non-HM eyes (axial length < 26.5 mm 29 eyes) at 4 and 12 weeks from baseline. We also assessed the IOP changes between the PM eyes (21 eyes) and the non-PM eyes (41 eyes). The significant IOP reduction by the ripasudil administration was observed at 4 weeks in the non-HM eyes and at 12 weeks in HM and non-HM eyes. And the IOP reduction in the HM eyes was significantly less than the non-HM eyes at 4 and 12 weeks. IOP reduction by ripasudil had statistically significant association with the baseline IOP and presence of PM. Furthermore, significant IOP reduction by the ripasudil administration was observed at 4 and 12 weeks in the non-PM eyes, but not in the PM eyes. The additional administration of ripasudil was effective in the HM eyes, but less than non-HM eyes. And the PM may negatively contribute to reducing the IOP by ripasudil.

Intraocular pressure-lowering and retina-protective effects of exosome-rich conditioned media from human amniotic membrane stem cells in a rat model of glaucoma

Intraocular pressure-lowering and retina-protective effects of exosome-rich conditioned media from human amniotic membrane stem cells in a rat model of glaucoma

Efficacy of preserved Tafluprost 0.0015% in lowering intraocular pressure.

To investigate the intraocular pressure (IOP) lowering effect of topical preserved tafluprost 0.0015% in a tertiary hospital setting in India. This is a retrospective chart review of patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) attending regular outpatient visits in December 2019 and January 2021, and treated with topical preserved tafluprost 0.0015%. Based on their medication history, patients were divided into two groups, the "treatment naïve" group and the "switched" group, which included patients switched to tafluprost monotherapy after treatment with at least one prior drug. The mean IOP of the study population reduced significantly from baseline level by 20.6% and 25.5% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The mean IOP in patients with only OHT reduced significantly from baseline level by 21% and 26% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The mean IOP in patients with POAG reduced significantly from baseline level by 19% and 24% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The baseline IOP ± SD in POAG treatment naïve patients was 25.3 ± 0.3 mmHg, which reduced significantly by 24% and 28% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). The baseline IOP ± SD in POAG switched patients was 24.3 ± 0.1 mmHg, which reduced significantly by 18% and 22% at 1 month and 3 months after preserved tafluprost 0.0015% treatment (P < 0.001 for both). In the POAG switch group, the percent reduction in IOP at 3 months after preserved tafluprost 0.0015% treatment was 23% with timolol as first line, 22% with bimatoprost as first line, 20% with latanoprost as first line, and 19% with travoprost as first line (P < 0.001 for all). We show significant IOP reduction with preserved tafluprost 0.0015% in a real-world setting. As first-line monotherapy in patients with OHT and in POAG-naïve patients, preserved tafluprost 0.0015% significantly reduced IOP at 3 months. Even as second-line therapy in nonresponders (POAG-Switched) to various drugs (same class [PGAs] versus different class), treatment with preserved tafluprost 0.0015% resulted in significant IOP reduction at 3 months.

Comparative efficacy of fixed dose combination of brinzolamide 1% and timolol 0.5% without versus with benzalkonium chloride following single ocular instillation in New Zealand white rabbits

Background: Benzalkonium chloride (BAK) is the most used preservative in topical ophthalmic formulations. BAK causes dry eye and trabecular meshwork degeneration. Hence, BAK-free formulations are desirable for chronic conditions like glaucoma. The objective of this study was to compare the efficacy of BAK-free versus BAK-containing ophthalmic suspension of fixed dose combination (FDC) of brinzolamide and timolol on their intraocular pressure (IOP) lowering effect following a single ocular instillation in New Zealand White (NZW) rabbits. Methods: Twelve normotensive NZW rabbits (male) between 9-12 months of age (3.4-4.4 kg) received a single ocular instillation (35 ml) in left eye of either ophthalmic suspension containing FDC of brinzolamide (1% w/v)/timolol (0.5% w/v) without BAK (n=6, test) or with BAK 0.01% w/v (n=6, reference). IOP was measured before ocular instillation (baseline) and at 2, 4, 6, 8 and 24 hours after instillation using a pneumatonometer. Change in IOP from baseline were calculated and analysed using repeated measures analysis of variance (ANOVA) followed by Bonferroni post-test for pairwise comparisons. Results: Significant IOP reduction (p&lt;0.05) from baseline was seen in both test and reference groups, up to 6 hours after instillation. Maximum IOP reduction was 25.5% and 22.6% at 2 hours in the test and reference group respectively. No significant differences (p&gt;0.05) were observed between the test and reference group for the change in IOP at all time points. Conclusions: BAK-free and BAK-containing ophthalmic suspension of FDC of brinzolamide 1% and timolol 0.5% after a single ocular instillation in normotensive NZW rabbits produces similar reductions in IOP.

Trabeculectomy Vs Non-penetrating Deep Sclerectomy for the Surgical Treatment of Open-Angle Glaucoma: A Long-Term Report of 201 Eyes.

Glaucoma is the second leading cause of vision loss worldwide. The reduction of intraocular pressure remains the backbone of its therapy. Among surgical techniques for its treatment, deep non-penetrating sclerotomy is the most widely practiced non-penetrating surgery. The purpose of this study was to evaluate the long-term efficacy and safety of deep non-penetrating sclerotomy compared to standard trabeculectomy in patients with open-angle glaucoma. Retrospective study including 201 eyes with open-angle glaucoma. Closed-angle and neovascular cases were excluded. Absolute success was considered when intraocular pressure under 18 mmHg, or a reduction of at least 20% in patients with a baseline intraocular pressure below 22 mmHg, was obtained after 24 months, without the use of medication. Qualified success was considered when those targets were met with or without the use of hypotensive medication. Deep non-penetrating sclerectomy showed a slightly lower long-term hypotensive effect compared to standard trabeculectomy, with significant differences at 12 months, but not at 24 months of follow-up. The absolute and qualified success rates were 51.85% and 65.43% for the trabeculectomy group and 50.83% and 60.83% for the deep non-penetrating sclerectomy, without significant differences. Regarding postoperative complications, mainly due to postoperative hypotonia, or related to the filtration bleb, they were significantly different between groups, with 10.8% and 24.7%, in deep-nonpenetrating sclerectomy and trabeculectomy groups, respectively. Deep non-penetrating sclerectomy seems to be an effective and safe surgical option for patients with open-angle glaucoma unable to be controlled by non-invasive strategies. Data suggests that the intraocular pressure-lowering effect of this technique may be marginally lower than that of trabeculectomy, but the achieved efficacy outcomes were similar, with a significantly lower risk of complications.

Timolol-loaded ethosomes for ophthalmic delivery: Reduction of high intraocular pressure in vivo

The beta-adrenoceptor blocker timolol maleate (TML) is a commonly used pharmaceutical agent for the management of glaucoma. Conventional eye drops have limitations due to biological or pharmaceutical factors. Therefore, TML-loaded ethosomes have been designed to mitigate these restrictions and give a viable solution for reducing elevated intraocular pressure (IOP). The ethosomes were prepared using the thin film hydration method. Integrating the Box-Behnken experimental strategy, the optimal formulation was identified. The physicochemical characterization studies were performed on the optimal formulation. Then, in vitro release and ex vivo permeation studies were conducted. The irritation assessment was also carried out with Hen's Egg Test–Chorioallantoic Membrane model (HET-CAM), and in vivo evaluation of the IOP lowering effect was also performed on rats. The physicochemical characterization studies demonstrated that the components of the formulation were compatible with each other. The particle size, zeta potential, and encapsulation efficiency (EE%) were found as 88.23 ± 1.25 nm, −28.7 ± 2.03 mV, and 89.73 ± 0.42 %, respectively. The in vitro drug release mechanism was found as Korsmeyer-Peppas kinetics (R2 = 0.9923). The HET-CAM findings verified the formulation's eligibility for biological applications. The IOP measurements revealed no statistical difference (p > 0.05) between the once-a-day application of the optimal formulation and the three-times-a-day application of the conventional eye drop. A similar pharmacological response was observed at lowered application frequencies. Therefore, it was concluded that the novel TML-loaded ethosomes could be a safe and efficient alternative for glaucoma treatment.

Machine learning-driven multifunctional peptide engineering for sustained ocular drug delivery

Sustained drug delivery strategies have many potential benefits for treating a range of diseases, particularly chronic diseases that require treatment for years. For many chronic ocular diseases, patient adherence to eye drop dosing regimens and the need for frequent intraocular injections are significant barriers to effective disease management. Here, we utilize peptide engineering to impart melanin binding properties to peptide-drug conjugates to act as a sustained-release depot in the eye. We develop a super learning-based methodology to engineer multifunctional peptides that efficiently enter cells, bind to melanin, and have low cytotoxicity. When the lead multifunctional peptide (HR97) is conjugated to brimonidine, an intraocular pressure lowering drug that is prescribed for three times per day topical dosing, intraocular pressure reduction is observed for up to 18 days after a single intracameral injection in rabbits. Further, the cumulative intraocular pressure lowering effect increases ~17-fold compared to free brimonidine injection. Engineered multifunctional peptide-drug conjugates are a promising approach for providing sustained therapeutic delivery in the eye and beyond.

Intraocular Pressure-Lowering and Retina-Protective Effects of Exosome-Rich Conditioned Media from Human Amniotic Membrane Stem Cells in a Rat Model of Glaucoma.

Glaucoma is one of the most devastating eye diseases, since the disease can develop into blindness and no effective therapeutics are available. Although the exact mechanisms and causes of glaucoma are unknown, increased intraocular pressure (IOP) has been demonstrated to be an important risk factor. Exosomes are lipid nanoparticles secreted from functional cells, including stem cells, and have been found to contain diverse functional molecules that control body function, inhibit inflammation, protect and regenerate cells, and restore damaged tissues. In the present study, exosome-rich conditioned media (ERCMs) were attained via hypoxic culture (2% O2) of human amniotic membrane mesenchymal stem cells (AMMSCs) and amniotic membrane epithelial stem cells (AMESCs) containing 50 times more exosome particles than normoxic culture (20% O2) medium (NCM). The exosome particles in ERCM were confirmed to be 77 nm in mean size and contain much greater amounts of growth factors (GFs) and neurotrophic factors (NFs) than those in NCM. The glaucoma-therapeutic effects of ERCMs were assessed in retinal cells and a hypertonic (1.8 M) saline-induced high-IOP animal model. CM-DiI-labeled AMMSC exosomes were found to readily penetrate the normal and H2O2-damaged retinal ganglion cells (RGCs), and AMMSC-ERCM not only facilitated retinal pigment epithelial cell (RPEC) proliferation but also protected against H2O2- and hypoxia-induced RPEC insults. The IOP of rats challenged with 1.8 M saline increased twice the normal IOP (12-17 mmHg) in a week. However, intravitreal injection of AMMSC-ERCM or AMESC-ERCM (3.9-4.5 × 108 exosomes in 10 μL/eye) markedly recovered the IOP to normal level in 2 weeks, similar to the effect achieved with platelet-derived growth factor-AB (PDGF-AB, 1.5 μg), a reference material. In addition, AMMSC-ERCM, AMESC-ERCM, and PDGF-AB significantly reversed the shrinkage of retinal layers, preserved RGCs, and prevented neural injury in the glaucoma eyes. It was confirmed that stem cell ERCMs containing large numbers of functional molecules such as GFs and NFs improved glaucoma by protecting retinal cells against oxidative and hypoxic injuries in vitro and by recovering IOP and retinal degeneration in vivo. Therefore, it is suggested that stem cell ERCMs could be a promising candidate for the therapy of glaucoma.

Factors defining the intraocular pressure-lowering effect of phacoemulsification and laser peripheral iridotomy in patients with primary angle closure : Factors defining IOP lowering effect of PE and LPI in PAC.

To identify whether gonioscopic ciliary body visibility and factors including anterior chamber depth (ACD), axial length (AL), acute attack history, and preoperative intraocular pressure (IOP) had any effect on IOP decrease in primary angle closure (PAC) and primary angle-closure glaucoma (PACG) after phacoemulsification (PE) and/or laser peripheral iridotomy (LPI). This retrospective-design study was conducted with 81 eyes with PAC and PACG; 33 eyes whose IOP was controlled with LPI and PE constituted group 1, and 48 eyes whose IOP was controlled using LPI alone comprised group 2. The effects on preoperative and last-visit IOP levels, ciliary body visibility, ACD, AL, and acute attacks were analyzed. Eyes within the groups were similar in AL, ACD, and preoperative IOP except for acute attack history, which was found to be higher in group 1. For group 1, none of the factors was found to have a differentiative effect on IOP decrease after PE, except eyes with preoperative IOP > 21mm Hg, which had significantly more IOP reduction. For group 2, no difference was found in ciliary body visibility, and higher or lower ACD. However, eyes with AL ≥ 22mm, positive acute attack history, and higher preoperative IOP were associated with significantly better IOP reduction. We found no relationship between ciliary body visibility and an IOP-reducing effect of PE and LPI. Although we found PE effective in IOP reduction in all eyes, we determined LPI to have a lesser IOP-reducing effect in eyes with IOP ≤ 21mm Hg and AL < 22mm.

AN EVALUATION OF EFFICACY OF COMMONLY USED FIRST LINE DRUGS IN TERMS OF INTRA OCULAR PRESSURE, OCULAR PERFUSION PRESSURE, AND FIELD OF VISION IN PATIENTS OF PRIMARY OPEN ANGLE GLAUCOMA OF NORTH KARNATAKA

Objective: The objective of the study was to measure the efficacy of commonly used timolol and latanoprost as first line drugs in terms of intra ocular pressure (IOP) and ocular perfusion pressure (OPP). Methods: This was an open-labeled, randomized, and prospective study conducted in the outpatient department of ophthalmology. Newly diagnosed patients were recruited into the study. A total of 60 patients were recruited into our study and were randomized in a 1:1 ratio into two groups of 30 each to receive either timolol 0.5% eye drops twice daily (Group 1) or latanoprost 0.005% eye drops once daily in the evening for a period of 6 weeks (n=30/group). A baseline general ophthalmic examination was done, and the patients were followed up at week 4 and week 6. Results: Latanoprost has a greater IOP lowering effect in patients with primary open angle glaucoma as compared to timolol and also concurrently increases Ocular perfusion pressure to a larger extent as compared to timolol. Conclusion: Latanoprost (left eye: 18.47 and right eye: 18.36) has a greater IOP lowering effect in patients with primary open angle glaucoma as compared to timolol (left eye: 20.4 and right eye: 20.7). Latanoprost (left eye: 57.13 and right eye: 57.20) also concurrently increases ocular perfusion pressure to a larger extent as compared to timolol (left eye: 54.15 and right eye: 55.33).

Physicochemical properties and micro-interaction between micro-nanoparticles and anterior corneal multilayer biological interface film for improving drug delivery efficacy: the transformation of tear film turnover mode

Recently, various novel drug delivery systems have been developed to overcome ocular barriers in order to improve drug efficacy. We have previously reported that montmorillonite (MT) microspheres (MPs) and solid lipid nanoparticles (SLNs) loaded with the anti-glaucoma drug betaxolol hydrochloride (BHC) exhibited sustained drug release and thus intraocular pressure (IOP) lowering effects. Here, we investigated the effect of physicochemical particle parameters on the micro-interactions with tear film mucins and corneal epithelial cells. Results showed that the MT-BHC SLNs and MT-BHC MPs eye drops significantly prolonged the precorneal retention time due to their higher viscosity and lower surface tension and contact angle compared with the BHC solution, with MT-BHC MPs exhibiting the longest retention due to their stronger hydrophobic surface. The cumulative release of MT-BHC SLNs and MT-BHC MPs was up to 87.78% and 80.43% after 12 h, respectively. Tear elimination pharmacokinetics study further confirmed that the prolonged precorneal retention time of the formulations was due to the micro-interaction between the positively charged formulations and the negatively charged tear film mucins. Moreover, the area under the IOP reduction curve (AUC) of MT-BHC SLNs and MT-BHC MPs was 1.4 and 2.5 times that of the BHC solution. Accordingly, the MT-BHC MPs also exhibit the most consistent and long-lasting IOP-lowering effect. Ocular irritation experiments showed no significant toxicity of either. Taken together, MT MPs may have the potential for more effective glaucoma treatment.

TUBE VERSUS TRABECULECTOMY IN JUVENILE-ONSET OPEN ANGLE GLAUCOMA - TREATMENT OUTCOMES IN TERTIARY HOSPITALS IN MALAYSIA.

To compare the intraocular pressure (IOP) lowering effect and postoperative complications between primary augmented trabeculectomy and glaucoma drainage device (GDD) implantation as primary surgical intervention in patients with juvenile-onset open angle glaucoma (JOAG). A retrospective review study involving 20 eyes that underwent primary augmented trabeculectomy with mitomycin (MMC) and 10 eyes GDD implantation in 3 tertiary centres in Malaysia between 1 January 2013 and 31 December 2019. They were followed up for at least 12 months postsurgical intervention. Intraocular pressure (IOP), number of topical IOP lowering medication and complications were evaluated at 1, 3, 6 and 12 months post-intervention. Based on the IOP, the success was divided into complete and partial success, and failure. IOP and postsurgical complications were compared using the Repetitive Measure Analysis of Variance (RM ANOVA) and the Pearson chi-square test. Both methods were effective in lowering the IOP. Eyes with primary augmented trabeculectomy have significant lower IOP compared to GDD implantation (p = 0.037). There was a higher incidence of postoperative hypotony (30%) in the trabeculectomy group. There was also a significant reduction of mean number of topical pressure-lowering drugs required postoperatively (p = 0.015). Complete success was achieved in 100% of eyes with trabeculectomy and 67% in GDD implantation (p = 0.047). Primary augmented trabeculectomy and GDD implantation are good surgical options for the treatment of JOAG. Both methods provide IOP lowering at 1 year. However, trabeculectomy provides better pressure lowering, compared to GDD implantation in patients with JOAG.

Rho kinase inhibitor for primary open‐angle glaucoma and ocular hypertension ‐ a Cochrane systematic review

AbstractPurpose: To compare the efficacy and safety of rho kinase inhibitor (ROKi) with placebo or other glaucoma medication in people diagnosed with open‐angle glaucoma (OAG), primary open‐angle glaucoma (POAG) or ocular hypertension (OHT).Methods: We searched CENTRAL, MEDLINE, Embase, PubMed, LILACS, ClinicalTrials and ICTRP for randomized clinical trials and controlled clinical trials with no restrictions of type, year, and publication status. Two review authors independently screened, extracted data, and evaluated risk of bias.Results: We included 17 trials (4953 participants) evaluating the efficacy and safety of marketed ROKI‐based drugs; netarsudil and ripasudil. Trial duration varied from 24 h to 12 months. The intraocular pressure (IOP) lowering effect of netarsudil may be superior to placebo (mean difference (MD) 3.11 mmHg 95% CI 2.59–3.62; low‐certainty evidence), but inferior to latanoprost (MD 0.97 mmHg 95% CI 0.67–1.27; moderate‐certainty) and timolol (MD 0.66 95% CI 0.41–0.91; low‐certainty). Combining netarsudil and latanoprost probably further reduces IOP compared with either netarsudil (MD 2.66 mmHg 95% CI 2.35–2.98; moderate‐certainty) or latanoprost (MD 1.64 mmHg 95% CI 1.11–2.16; moderate‐certainty). Combining ripasudil and timolol may probably reduce IOP compared with timolol monotherapy (MD 0.75 mmHg 95% CI 0.21–1.29; moderate‐certainty). The certainty of evidence reporting ocular adverse events (AEs) was very low or low. However, compared to timolol, netarsudil (21 additional ocular AEs per 100‐person‐months 95% CI 14–27; moderate‐certainty) and combination therapy with ripasudil/timolol (35 additional ocular AEs per 100 person‐months 95% CI 25–45; moderate‐certainty) probably lead to more ocular AEs. ROKi was not associated with any particular serious AEs.Conclusions: The current evidence suggests that in people diagnosed with OHT or (P)OAG, the hypotensive effect of netarsudil may be inferior to latanoprost and slightly inferior to timolol. Combining netarsudil and latanoprost probably further reduces IOP compared with monotherapy. However, differences are small and may not be clinically significant. Netarsudil as mono‐ or combination therapy may result in more ocular AEs, but the evidence on AEs is limited.