Mean Decrease In Intraocular Pressure Research Articles

Effects of topical application of a 2% solution of dorzolamide on intraocular pressure and aqueous humor flow rate in clinically normal dogs.

To evaluate effects of topical application of a 2% solution of dorzolamide on intraocular pressure (IOP) and aqueous humor flow rate in clinically normal dogs. 15 Beagles. The IOP was measured in both eyes of all dogs for 3 days to determine baseline values. In a single-dose study, 50 microl of dorzolamide or control solution was applied in both eyes at 7:00 AM, and IOP was measured 7 times/d. In a multiple-dose study, dorzolamide or control solution was applied to both eyes 3 times/d for 6 days, and IOP was measured 4 times/d during treatment and for 5 days after cessation of treatment. Aqueous humor flow rate was measured for all dogs fluorophotometrically prior to treatment and during the multiple-dose study. In the single-dose study, dorzolamide significantly decreased IOP from 30 minutes to 6 hours after treatment. Mean decrease in IOP during this time span was 3.1 mm Hg (18.2%). Maximal decrease was detected 6 hours after treatment (3.8 mm Hg, 22.5%). In the multiple-dose study, dorzolamide decreased IOP at all time points, and maximal decrease was detected 3 hours after treatment (4.1 mm Hg, 24.3%). Mean aqueous humor flow rate decreased from 5.9 to 3.4 microl/min (43%) after treatment in the dorzolamide group. Topical application of a 2% solution of dorzolamide significantly decreases IOP and aqueous humor flow rate in clinically normal dogs. Therefore, topical administration of dorzolamide should be considered for the medical management of dogs with glaucoma.

Effect of intracameral acetylcholine on latanoprost in preventing ocular hypertension after phacoemulsification and intraocular lens implantation

Purpose To evaluate the effect of intracameral acetylcholine on latanoprost in preventing ocular hypertension in the early period after phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. Setting Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong, China. Methods Patients with uncomplicated cataract having phacoemulsification with PC IOL implantation were included in this prospective randomized double-masked clinical trial. The eyes were randomly assigned to 1 of 4 groups based on postoperative application of latanoprost 0.005% alone (Group 1), latanoprost 0.005% with intracameral acetylcholine (Group 2), intracameral acetylcholine alone (Group 3), and no medication (controls (Group 4). Intraocular pressure (IOP) was measured 3 and 24 hours postoperatively. The anterior chamber was examined for the level of cells and flare using slitlamp biomicroscopy. Results Three and 24 hours after surgery, the decrease in mean IOP in eyes receiving latanoprost alone was not statistically significantly different from that in control eyes ( P > .05). Eyes receiving intracameral acetylcholine alone had a significant decrease in the mean IOP at 3 hours ( P < .05) but not at 24 hours compared to control eyes ( P > .05). There were no significant differences in the mean postoperative IOP decrease between eyes receiving latanoprost with intracameral acetylcholine and those receiving intracameral acetylcholine alone ( P > .05). Conclusions A single application of latanoprost did not significantly lower IOP in the first 24 hours after phacoemulsification with PC IOL implantation. Eyes receiving intracameral acetylcholine alone had a significantly greater decrease in IOP than control eyes at 3 hours but not at 24 hours. The addition of intracameral acetylcholine to latanoprost did not enhance or reduce latanoprost’s IOP-lowering effect.

Efficacy of brimonidine 0.2% and dorzolamide 2% as adjunctive therapy to beta-blockers in adult patients with glaucoma or ocular hypertension

Background: The alpha-adrenergic agonist brimonidine and the carbonic anhydrase inhibitor dorzolamide have been studied both as monotherapy and in combination with beta-blockers in the treatment of glaucoma and ocular hypertension; however, a MEDLINE ® literature search failed to reveal any clinical studies directly comparing these 2 agents as adjunctive therapy. Objective: The purpose of this study was to compare the intraocular pressure (IOP)-lowering efficacy of brimonidine and dorzolamide as adjunctive therapy to beta-blockers in adult patients with glaucoma or ocular hypertension. Methods: In a prospective, investigator-masked, multicenter, parallel-design clinical trial, adult patients whose IOP was inadequately controlled with topical beta-blocker therapy were randomly assigned to receive brimonidine 0.2% twice daily or dorzolamide 2% 3 times daily as adjunctive therapy for 3 months. Efficacy was determined by the reduction in IOP from baseline. After 1 month of adjunctive treatment, patients who failed to meet a target 15% reduction in IOP at peak drug effect were crossed over to the other study medication. Results: A total of 106 patients were treated. Approximately 70% ( 74 106 ) of the patients were white, and 61.3% ( 65 106 ) had a diagnosis of open-angle glaucoma. Mean baseline IOP (ie, with beta-blocker monotherapy) was comparable between treatment groups (∼21 mm Hg). After 1 month of adjunctive treatment, the mean daily IOP reduction was significantly greater with brimonidine (4.40 mm Hg, 20.4%) than with dorzolamide (3.0 mm Hg, 14.4%; P = 0.033). At peak drug effect at month 1, the mean IOP reduction was significantly greater in the brimonidine group (5.95 mm Hg, 27.6%) than in the dorzolamide group (4.11 mm Hg, 19.7%; P = 0.007). Significantly more patients treated with brimonidine ( 44 51 , 86.3%) than with dorzolamide ( 29 47 , 61.7%) achieved the target 15% reduction in IOP at month 1 ( P = 0.005). At month 3, the mean daily IOP reduction and the mean IOP reduction at peak drug effect were not significantly different in the 2 treatment groups. The mean daily IOP reduction was 4.98 mm Hg in the brimonidine group and 3.15 mm Hg in the dorzolamide group ( P = 0.092). At peak drug effect, the mean IOP reduction was 6.39 mm Hg with brimonidine and 4.06 mm Hg with dorzolamide. The incidence of adverse events leading to discontinuation was 9.3% ( 5 54 ) in the brimonidine group (depression, 2; allergic conjunctivitis, 1; dry mouth and tearing, 1; dermatitis, 1) and 9.8% ( 5 51 ) in the dorzolamide group (ocular burning and stinging, 2; ocular itch, 1; gastrointestinal complaints, 1; lack of tolerance for beta-blocker, 1), with no significant difference between groups. Conclusion: In this trial, brimonidine 0.2% twice daily produced greater mean decreases in IOP and was effective in more patients than dorzolamide 2% 3 times daily when used as adjunctive therapy to beta-blockers.

Efficacy and tolerability of timolol maleate ophthalmic gel-forming solution versus timolol ophthalmic solution in adults with open-angle glaucoma or ocular hypertension: a six-month, double-masked, multicenter study

Background: Timolol has been formulated in a highly purified gellan gum to improve its duration of action. The efficacy of this formulation in short-term studies using once-daily dosing has been reported. Objective: The purpose of this study was to evaluate the efficacy and tolerability of 0.5% timolol maleate ophthalmic gel-forming solution (timolol GS) given once daily versus 0.5% timolol solution given twice daily in a long-term trial. Methods: This was a multicenter, double-masked, 6-month trial. After a washout of ocular hypotensive medication, 286 patients with open-angle glaucoma or ocular hypertension were randomly assigned in a 2:1 ratio to receive 0.5% timolol GS in both eyes once daily or 0.5% timolol solution in both eyes twice daily. All patients received a morning (9 am) and evening (9 pm) dose. For patients in the timolol GS group, the evening doses consisted of a vehicle only, whereas for patients in the timolol solution group, both doses consisted of active drug. Intraocular pressure (IOP) was measured at trough (before morning instillation) and peak (2 hours after instillation) at follow-up examinations at weeks 2, 4, 8, 12, and 24. Adverse events were monitored using patient reports. Results: Of the 286 patients randomized, 191 received timolol GS and 95 received timolol solution. Ninety-three percent of patients ( 265 286 ) completed the study. At the end of the treatment interval (week 24), the mean decrease in IOP at trough ranged from 5.6 to 5.9 mm Hg in the timolol GS group and from 6.3 to 6.6 mm Hg in the timolol solution group. Similar efficacy was observed at 11 am (peak). At week 24, the difference in mean IOP between treatments was −0.61 mm Hg (95% CI −1.44 to 0.22) at trough and −0.79 mm Hg (95% CI −1.77 to 0.20) at peak, indicating no significant difference between the 2 timolol formulations. The number of reports of blurred vision and tearing was significantly higher in the timolol GS group than in the timolol solution group ( P = 0.04), whereas burning/stinging was reported more frequently in the timolol solution group than in the timolol GS group ( P = 0.04). At week 12, the decrease in mean heart rate at trough (hour 0) was significantly less for patients in the timolol GS group than for those in the timolol solution group (−1.1 vs −4.2 bpm; P = 0.024). At week 24 (hour 0), the decrease in mean heart rate was less for patients treated with timolol GS by 2.5 bpm ( P = 0.051). The heart rate data at peak (hour 2) was similar to that observed at trough at week 12 (−2.7 vs −5.7 bpm; P = 0.006) and week 24 (−3.1 vs −4.7 bpm; P = 0.063). The mean change in blood pressure was not significantly different between treatments. There were no clinically significant differences between the groups in visual acuity, biomicroscopy and ophthalmoscopy results, or visual fields. Conclusions: Timolol 0.5% GS administered once daily was shown to be as effective in lowering IOP as the equivalent concentration of timolol 0.5% solution administered twice daily in patients with ocular hypertension or open-angle glaucoma.

Patients' acceptance of a switch from dorzolamide to brinzolamide for the treatment of glaucoma in a clinical practice setting

Background: The first topically active carbonic anhydrase inhibitor, dorzolamide, was developed to circumvent the adverse systemic effects of oral carbonic anhydrase inhibitors. However, its use has been associated with ocular discomfort. Objective: The present study examined the acceptability of brinzolamide, as measured by patients' ratings and stated preferences, in patients with glaucoma previously treated with dorzolamide in the clinical practice setting. Methods: This was a prospective, open-label, noncomparative study conducted shortly after the approval of brinzolamide. Ophthalmologists in private practice in the continental United States were asked to select patients currently using dorzolamide as their sole or combination therapy for glaucoma. Patients underwent a screening assessment in which they were asked to rate their ocular comfort with dorzolamide on a scale from 1 to 6. Brinzolamide was then substituted for dorzolamide, and patients returned for a follow-up visit ∼1 to 3 months later. At this visit, patients were asked about ocular comfort, their preferred medication, and whether they thought ocular comfort influenced their adherence to treatment. Intraocular pressure (IOP) was measured at both visits. Results: Valid visit dates (ie, both baseline and follow-up dates) were available for 447 of 501 patients from 68 of 73 sites (range, 1–40 patients per site). Because not all measurements were available for all patients at each visit, the sample size varied for each measurements. Demographic data were not available. The switch to brinzolamide resulted in a mean decrease in IOP of ∼0.8 mm Hg ( P < 0.001, paired t test). Sixty-nine percent of patients ( 274 397 ) reported an improvement of ≥1 grade in their comfort rating with brinzolamide versus dorzolamide. The mean (± SD) improvement in comfort rating was 1.43 ± 1.48 grades ( P < 0.001, Wilcoxon rank sum test). When patients were asked whether their adherence to treatment was affected by the occurrence of burning and stinging, 43% ( 173 399 ) answered affirmatively. Fifty-nine percent ( 251 424 ) preferred brinzolamide to dorzolamide. At the end of the study, based on patient preference, physician judgment, and other factors, 73% of responding patients ( 301 410 ) continued with brinzolamide therapy. Conclusions: In this study, the switch from dorzolamide to brinzolamide resulted in overall improvements in comfort and ocular hypotensive efficacy. However, studies using a more rigorous randomized, controlled, crossover design are needed to support these observations.

Correlation between intraocular pressure and corneal stromal thickness after laser in situ keratomileusis

Purpose To assess the relationship between intraocular pressure (IOP) and corneal stromal thickness following laser in situ keratomileusis (LASIK) for myopia or myopic astigmatism. Setting Private clinic in Turkey. Methods The database of patients who had LASIK was retrospectively reviewed. Preoperative and postoperative IOP and corneal thickness were measured in both eyes of 353 patients by noncontact tonometry and ultrasonic pachymetry, respectively. The correlation between changes in IOP and corneal thickness was evaluated by regression analysis. Results Laser in situ keratomileusis was associated with a mean decrease in pachymetry of 46.7 μm ± 28.9 (SD) and a mean decrease in IOP of 2.8 ± 2.1 mm Hg. There was a significant correlation between the decreases in IOP and pachymetry ( P < .001). Conclusion The decrease in IOP after LASIK was related to the decrease in corneal stromal thickness, although there may be other contributing factors.

Comparison of the Clinical Success Rates and Quality of Life Effects of Brimonidine Tartrate 0.2% and Betaxolol 0.25% Suspension in Patients With Open-Angle Glaucoma and Ocular Hypertension

To compare the clinical effectiveness and the impact on quality of life of twice-daily brimonidine 0.2% with those of twice-daily betaxolol 0.25% in patients with glaucoma or ocular hypertension. A prospective, double-masked, randomized, comparative, multicenter, 4-month "real-life" clinical trial involving 188 patients. Medications were instilled twice daily. Efficacy was determined through measurement of intraocular pressure; safety and tolerability were measured using reports of adverse events, a quality of life survey (Glaucoma Disability Index), heart rate, and blood pressure. Patients with an inadequate response in intraocular pressure after 1 month or those who experienced significant adverse events in the first month were switched to the alternative study arm and remained taking the alternative medication for a total of 4 months or left the study. The main outcome measure was clinical success, as determined by evaluation of the efficacy, safety, and tolerability of drug treatment, and was achieved when the investigator recommended that the patient continue the treatment after completion of the study. As initial therapy, clinical success was achieved in 74% of patients treated with brimonidine, as compared with 57% of patients treated with betaxolol (P = 0.027). The overall mean decrease in intraocular pressure from baseline was 5.9 mm Hg with brimonidine and 3.8 mm Hg with betaxolol. Both treatments were well tolerated, and there were no significant between-group differences in the incidence of adverse events or in the quality of life summary scores. Twice-daily brimonidine 0.2% and betaxolol 0.25% suspension were safe and effective as first-line therapy for glaucoma and ocular hypertension. In this study, brimonidine showed clinical effectiveness superior to that of betaxolol.

Optic disk topography after medical treatment to reduce intraocular pressure

PURPOSE: We examined changes in optic disk topography using confocal scanning laser ophthalmoscopy after reducing intraocular pressure with administration of latanoprost. METHODS: Twenty-nine patients with glaucoma or ocular hypertension were imaged using the Heidelberg Retina Tomograph before and after the administration of latanoprost to decrease intraocular pressure. Average time between pretreatment and posttreatment imaging was 2.7 ± 1.8 weeks. Heidelberg Retina Tomograph software–measured parameters were mean height of contour, cup area, cup volume, mean cup depth, maximum cup depth, cup shape, rim area, rim volume, cup-to-disk ratio, and retinal nerve fiber thickness. RESULTS: Average intraocular pressure decreased significantly (mean ± SD) by 7.2 ± 5.4 mm Hg (25 ± 16% decrease). No statistically significant changes in measured topographic parameters were found. When data from patients with decreases in intraocular pressure of 7 mm Hg or greater were analyzed separately (mean intraocular pressure decrease = 10.79 ± 4.32 mm Hg, 36 ± 8% decrease), cup area ( P = .005), cup volume ( P = .002), and cup-to-disk ratio ( P = .005) decreased significantly, and rim area ( P = .005) increased significantly. Linear regression analysis of the data from all subjects showed that a change in intraocular pressure after latanoprost administration accounted for 12% or more of the variance in two measured topographic parameters (mean cup depth and cup shape). CONCLUSIONS: These results suggest that, in some patients, moderate decreases in intraocular pressure may affect disk topography, as measured by Heidelberg Retina Tomograph. Intraocular pressure should be considered when analyzing consecutive confocal scanning laser ophthalmoscopy images for glaucomatous progression.

Long-term brimonidine therapy in glaucoma patients with apraclonidine allergy

PURPOSE: To report the use of brimonidine in patients with a documented ocular allergy to apraclonidine. METHODS: We conducted a prospective, open-label study on the use of long-term brimonidine therapy in 57 patients with chronic glaucoma with documented allergy to apraclonidine. The study patients were placed on brimonidine tartrate 0.2%, 1 drop three times daily in one or both eyes, either as additive therapy to a medical regimen devoid of apraclonidine for further lowering of intraocular pressure (25 patients) or as a replacement for apraclonidine at the time of diagnosis of apraclonidine ocular allergy for maintenance of intraocular pressure control (32 patients). Clinical symptoms and signs of ocular allergy to brimonidine were monitored for up to 18 months. RESULTS: During the treatment period of up to 18 months, six (10.5%) of 57 patients developed slit-lamp biomicroscopic findings and subjective symptoms of an ocular allergic reaction that led to discontinuation of brimonidine treatment. All six patients developed ocular allergy to topical brimonidine 0.2% during the first 4 months of therapy. The addition of brimonidine 0.2% topical medication or the replacement of apraclonidine with brimonidine resulted in a significant decrease in mean intraocular pressure from 20.5 ± 5.3 to 16.5 ± 4.2 mm Hg ( P < .0001) at the mean treatment period of 10.6 ± 4.6 months (range, 0.5 to 18.0 months in all 57 patients: 5 to 18 months in the 51 patients without brimonidine allergy and 0.5 to 3.8 months in the six patients who developed brimonidine allergy. CONCLUSIONS: The incidence of ocular allergy after the use of brimonidine 0.2% topical medication for up to 18 months was 10.5% in patients with a documented history of apraclonidine allergy. Therefore, it is generally safe as well as efficacious to administer brimonidine to patients with an ocular allergy to apraclonidine.

Brimonidine tartrate 0.2% twice daily vs timolol 0.5% twice daily: 1-year results in glaucoma patients

PURPOSE: To compare the long-term efficacy and safety of brimonidine 0.2% twice daily with timolol 0.5% twice daily in patients with glaucoma or ocular hypertension. METHODS: Of the 926 patients enrolled in the study, 837 met the protocol entry criteria and received either brimonidine 0.2% twice daily (n = 466) or timolol 0.5% (n = 371) twice daily in each eye for 1 year. RESULTS: Brimonidine and timolol significantly reduced mean intraocular pressure ( P < .001) from baseline levels at every scheduled follow-up visit, both at hour 2 (peak) and hour 12 (trough). At weeks 1 and 2 and months 3 and 12, significantly greater mean decreases in intraocular pressure ( P < .040) at peak were observed in patients treated with brimonidine than those treated with timolol. The mean intraocular pressure decrease at trough was significantly greater for timolol than for brimonidine at each follow-up visit ( P < .001). With the exception of ocular allergy (in 11.5% of patients using brimonidine and less than 1% using timolol), fewer than 3% of patients in either treatment group withdrew from the study prematurely as a result of a specific adverse event. Patients receiving timolol experienced significant decreases in heart rate ( P < .001) from baseline at all follow-up visits. No significant changes in heart rate were seen in patients treated with brimonidine. Neither medication produced clinically significant changes in blood pressure. CONCLUSION: Brimonidine is safe and effective in the long-term lowering of intraocular pressure in patients with glaucoma or ocular hypertension, with efficacy comparable to that of timolol but without a notable negative chronotropic effect on the heart.

Twelve-month results of an ongoing randomized trial comparing brimonidine tartrate 0.2% and timolol 0.5% given twice daily in patients with glaucoma or ocular hypertension

Objective To compare the long-term safety and ocular-hypotensive efficacy of brimonidine tartrate 0.2% with timolol maleate 0.5% administered twice daily in patients with glaucoma or ocular hypertension. Design A double-masked, parallel-group, active-controlled, multicenter clinical trial of 12 months’ duration. Participants Four hundred eighty-three patients with glaucoma or ocular hypertension were enrolled. Of these, 463 were evaluated according to the protocol criteria (280 in the brimonidine tartrate group and 183 in the timolol group). Interventions Brimonidine tartrate 0.2% or timolol maleate 0.5% was administered twice daily. Main outcome measures The primary efficacy variable was intraocular pressure (IOP). Results Brimonidine and timolol produced significant ( P < 0.001) and sustained mean reductions in IOP throughout the 1-year follow-up when measured at hour 0 (trough) and at hour 2 (peak). At weeks 1 and 2 and month 12, significantly greater mean decreases in IOP measured at peak ( P ≤ 0.007) were observed in patients treated with brimonidine as compared to timolol, whereas the mean decrease in IOP measured at trough was significantly greater in patients treated with timolol as compared to brimonidine ( P < 0.001) at all follow-up visits. Both drugs were well-tolerated. The incidence of adverse events was similar in both treatment groups, except for ocular allergy, oral dryness, and conjunctival follicles, which occurred more frequently in the brimonidine group, and burning-stinging, which occurred more frequently in the timolol group. Patients receiving timolol experienced significant decreases in heart rate at all follow-up visits. Conclusions Topically applied twice daily for 12 months, brimonidine tartrate 0.2% was safe and effective in lowering IOP in patients with glaucoma or ocular hypertension.

The advanced glaucoma intervention study (AGIS): 4. comparison of treatment outcomes within race: Seven-year results

Objective The purpose of this report is to present separately for black and white patients with advanced glaucoma 7-year results of two alternative surgical intervention sequences. Design A randomized controlled trial. Participants A total of 332 black patients (451 eyes), 249 white patients (325 eyes), and 10 patients of other races (13 eyes) participated. Potential follow-up ranged from 4 to 7 years. Intervention Eyes were randomly assigned to either an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy (ATT) sequence or a trabeculectomy-ALT-trabeculectomy (TAT) sequence. The second and third interventions were offered after failure of the first and second interventions, respectively. Main outcome measures Average percent of eyes with decrease of visual field (APDVF), average percent of eyes with decrease of visual acuity (APDVA), and average percent of eyes with decrease of vision (APDV) are the outcome measures. Decrease of visual field (DVF) is an increase from baseline of at least 4 points on a glaucoma visual field defect scale ranging from 0 to 20, decrease of visual acuity (DVA) is a decrease from baseline of at least 15 letters (3 lines), and decrease of vision (DV) is the occurrence of either DVF or DVA. The averages are of percent decreases observed at 6-month intervals from the first 6-month visit to the end of the specified observation period. Results In both black and white patients throughout 7-year follow-up, the mean decrease in intraocular pressure was greater in eyes assigned to TAT, and the cumulative probability of failure of the first intervention was greater in eyes assigned to ATT. In black patients, APDVF, APDVA, and APDV are less for the ATT sequence than for the TAT sequence throughout the 7 years. In white patients, APDVF also favors the ATT sequence but only for the first year, after which it favors the TAT sequence through the seventh year; APDVA also favors the ATT sequence, but the ATT-TAT difference progressively diminishes over 7 years; and APDV favors ATT over TAT initially, but after 4 years, the advantage switches to and remains with TAT. Conclusions These data support use of the ATT sequence for all black patients. For white patients without life-threatening health problems, the data support use of the TAT sequence.

Intraocular pressure change measured by Goldmann tonometry after laser in situ keratomileusis

Purpose: To assess the accuracy of Goldmann tonometry after laser in situ keratomileusis (LASIK).Setting: University-based refractive surgery group (Clinique du Laser Visuel).Method: The database of patients who had LASIK was retrospectively reviewed. Preoperative and postoperative intraocular pressure (IOP) was measured in 145 patients. The correlation between decrease in IOP and various preoperative and intraoperative parameters was evaluated by regression analysis. Only one eye in patients having bilateral surgery was used for statistical analysis.Results: Laser in situ keratomileusis was associated with a mean decrease in IOP of 1.9 mm Hg ± 2.9 (SD). There was no significant correlation between the decrease and any parameter evaluated.Conclusion: Intraocular pressure after LASIK decreased by a mean of 1.9 ± 2.9 mm Hg. The cause of the decrease remains unknown.

Phacotrabeculectomy: Comparison of Results From 3.5- and 5.2-mm Incisions

To compare the intraocular pressure control, visual results, and astigmatic results of 3.5-mm and 5.2-mm incisions following phacotrabeculectomy with 12 months of follow-up. Fifty eyes underwent clear cornea punch trabeculectomy under a 5.0 x 2.5-mm scleral flap, closed with two 10-0 polyglactin sutures. The first 25 eyes underwent wound extension to 5.2 mm for insertion of a single-piece polymethylmethacrylate (PMMA) lens. The next 25 eyes underwent wound extension to 3.5 mm for insertion of a folded silicone lens. The mean intraocular pressure decrease from the preoperative level was 7.6 mm Hg in the 3.5-mm incision group and 7.8 mm Hg in the 5.2-mm incision group. One patient required continued medication. The best-corrected visual acuity was 20/40 or better in 86% of the patients, with no significant difference between the groups. The mean "with the wound" induced astigmatism showed no statistical difference between the two groups. The use of 10-0 polyglactin appears to aid filtration, yet minimizes hypotony or the need for antimetabolites. For surgeons who wish to reduce costs without compromising results during phacotrabeculectomy, there is merit in considering a 5.2-mm incision; moreover, the more rigid single-piece PMMA lens appears to be associated with fewer complications in the immediate postoperative period.

Transscleral diode laser cyclophotocoagulation for refractory pediatric glaucomas.

To evaluate the success of contact transscleral cyclophotocoagulation (TDC) in patients with refractory pediatric glaucomas. Twenty-six eyes of 20 patients with therapy-resistant pediatric glaucomas were included in this retrospective study. Subgroup analysis was performed for patients 10 or younger and patients older than 10 at time of first TDC procedure. Diode laser cyclophotocoagulation was applied using a fiber optic G-probe. Follow up until time of failure or for a minimum of 6 months was obtained for all procedures in all eyes. Failure was defined as intraocular pressure (IOP) greater than 21 mm Hg, repeat of TDC due to clinically inadequate IOP control, progression to another procedure, or serious complication. Baseline mean pretreatment IOP was 34.2 +/- 10.4 mm Hg (range, 15 to 62 mm Hg). Ten of 26 eyes (38%) were successful 6 months after initial TDC. A mean decrease in IOP of 10.3 +/- 14.7 mm Hg was noted after the first procedure (P < 0.05). Eighteen eyes (70%) were retreated at least once. The mean decrease in IOP for all patients after all procedures was 12.9 +/- 13.4 mm Hg (P < 0.001). This represents a mean percent decrease in IOP of 33.2 +/- 6.9%. The overall success rate was 50%, including retreated patients. The younger and older subgroups did not differ with regard to overall success, time to failure, or retreatment rats. One patient suffered a retinal detachment. Visual loss was noted in 4 of 22 eyes with reliable visual acuity measurements. TDC is an effective means of decreasing IOP in some patients with refractory pediatric glaucomas. Although the retreatment rate is high, the procedure generally is well tolerated with few complications.

The Role of Mitomycin Treatment Duration and Previous Intraocular Surgery on the Success of Trabeculectomy Surgery

This study was performed to determine the effect of duration of mitomycin exposure during trabeculectomy surgery on filtration success in eyes that had and had not been subjected to previous surgery. On hundred six eyes of 92 patients were retrospectively reviewed. The effect of previous surgery and exposure duration of mitomycin 0.5 mg/ml on outcomes of trabeculectomy surgery were evaluated. The mean duration of mitomycin exposure was 0.7 +/- 0.02 min (mean +/- SEM) in the eyes that had not been subjected to previous surgery and 1.5 +/- 0.11 min in the eyes that had (p < 0.001). The mean follow-up times were 14 months in both groups. The mean decrease in intraocular pressure was 13.6 +/- 1.25 mm Hg in the group that had not been subjected to previous surgery and 13.9 +/- 1.45 mm Hg in the group that had been subjected to previous surgery. Analysis of variance techniques demonstrated no predictive value of demographics, history of previous surgery, or duration of mitomycin exposure with results of trabeculectomy surgery. Hypotony was the most frequent complication in both the no previous surgery and the previous surgery groups. The incidence of complications was numerically greater in the group that had not been subjected to previous surgery. The duration of mitomycin exposure and the history of previous surgery did not correlate with postoperative intraocular pressure, medications, or incidence of complications. The exposure duration response curve of mitomycin 0.5 mg/ml in these patients appears to be flat through the time evaluated. Lower concentrations of mitomycin and shorter exposure should be used to maintain efficacy with reduced risk of complications.

Experimental use of space-retaining substances with extended duration: functional and morphological results.

In glaucoma surgery, e.g. cyclodialysis ab interno, to date no viscous substances have been available that stay in the cyclodialysis cleft long enough to prevent scarring. We examined the qualities of two different viscoelastic substances that stay longer in the place of instillation than hyaluronic acid. We performed cyclodialysis ab interno in 12 eyes of six owl monkeys. The right eyes were treated with the gel with the higher molecular weight, the left eyes using the gel with the lower molecular weight. The baseline data of intraocular pressure and outflow facility were compared to the values measured postoperatively up to the 140th day. Histological examination of the eyes followed. There was no statistically significant difference between the two substances. The mean intraocular pressure decrease was 7.9 (+/- 2.9) mmHg in the right eyes and 4.8 (+/- 2.7) mmHg in the left eyes. The histological examination showed that the gel had remained in the cyclodialysis cleft without signs of inflammation. In contrast to other viscoelastic substances studied previously, the substances in this study performed their space-retaining function without decreasing outflow facility. Both substances are suitable means of improving the rate of success of cyclodialysis ab interno, as they remain where they are instilled long enough to prevent wound scarring in the cyclodialysis cleft.

Effect of exercise on the intraocular pressure of Hong Kong‐Chinese

The effect of exercise on the intraocular pressure (IOP) of two groups of Hong Kong (HK)-Chinese was studied. Twenty-three HK-Chinese in two age groups had IOP measured before and after mild exercise (stepping up and down on a step 228 mm in height for three minutes). The young group was aged 29 years (range 24 to 33 years) and the elderly group was aged 57 years (range 50 to 64 years). The mean (± standard deviation) IOP was 11.1 ± 2.2 mmHg for the young group and 11.2 ± 3.4 mmHg for the elderly group. There was no significant difference in the mean IOP between the two groups. There was a significant decrease in IOP after the exercise. The exercise produced an immediate decrease in mean IOP of 2.2 mmHg and 1.6 mmHg in the young and elderly groups, respectively. The mean IOP returned to the pre-exercise level 40 minutes after exercise for the young group and 30 minutes after exercise for the elderly group. (Clin Exp Optom 1995; 78: 3: 83–86)

Long-term Efficacy of Argon Laser Trabeculoplasty: A 10-year Follow-up Study

Argon laser trabeculoplasty (ALT) is commonly used in the treatment of open-angle glaucoma. Varying success rates in lowering intraocular pressure (IOP) and controlling glaucoma are reported in studies with follow-up periods from 1 to 5 years, and few reports are available with follow-up to 10 years. The authors retrospectively reviewed the efficacy of ALT in patients followed up to 10 years. Ninety-three patients with open-angle glaucoma underwent 360 degrees ALT. Mean follow-up was 52 +/- 43 months (mean +/- standard deviation; range, 1-132 months). Successful treatment at the time of final follow-up was defined as a decrease in IOP of 3 mmHg or greater from pretreatment level, IOP of 19 mmHg or less, stable visual field, stable optic nerve, and no further laser or surgical intervention. The decrease in IOP was 8.9 +/- 5.4 mmHg at 1 year, 10.0 +/- 4.2 mmHg at 5 years, and 8.9 +/- 5.2 mmHg at 10 years. The probability of success at 1 year was 77%, at 5 years 49%, and at 10 years 32%. Failure was most common in the first year after treatment (23%), and thereafter failure occurred at a rate of 5% to 9% per year. The mean decrease in IOP for all 93 eyes at time of maximum follow-up was 6.1 +/- 7.1 mmHg. Argon laser trabeculoplasty is an effective means for reducing IOP in many patients followed for an extended time. However, up to one half of eyes within 5 years of ALT and two thirds of eyes within 10 years may require additional laser or surgical intervention for glaucoma control.

Evaluation of Once-Daily Levobunolol 0.25% and Timolol 0.25% Therapy for Increased Intraocular Pressure

In a three-month, double-masked, randomized clinical trial, we evaluated the once-daily ocular hypotensive efficacy of 0.25% levobunolol and 0.25% timolol in 80 patients with open-angle glaucoma or ocular hypertension. Thirty-seven of the 39 patients (95%) in the 0.25% levobunolol group and 35 of the 41 patients (85%) in the 0.25% timolol group successfully completed the three-month study period. The overall mean decrease in intraocular pressure was 5.3 mm Hg (22%) in the 0.25% levobunolol group and 5.4 mm Hg (22%) in the 0.25% timolol group. This difference was not statistically significant. In both treatment groups, effects on mean heart rate and blood pressure were minimal. The data suggest that levobunolol 0.25% and timolol 0.25%, administered once daily, are equally effective in the treatment of open-angle glaucoma and ocular hypertension.