Mean IOP Change Research Articles

A retrospective review of selective laser trabeculoplasty outcomes at Lancashire Teaching Hospitals, UK.

Selective laser trabeculoplasty has been carried out at Lancashire Teaching Hospitals over the past seven years. This work aimed to review the use of SLT in this Trust. The primary objectives were to establish the efficacy of SLT in reducing intraocular pressure, to analyse how prior treatment with different topical medications can influence SLT outcomes and to analyse the outcomes in revisionary patients. We conducted a retrospective review of 288 eyes, with a known history of glaucoma or ocular hypertension and who underwent initial SLT laser treatment between October 2018 and January 2020. SLT was performed on known glaucoma and treatment naïve patients where IOP control was deemed sub-optimal. All patient data was fully anonymised. We found that SLT was effective in lowering IOP. Around two-thirds of the eyes (181/280, 65%) achieved a reduction in IOP of 10% or more. Just under half (127/280, 45%) achieved a reduction of 20% or more. For a pre-SLT IOP of 14.6 mmHg, we found that no mean change in IOP is expected, and for each 1 mmHg by which the pre-SLT IOP exceeds this threshold, the mean reduction in IOP is expected to be 0.61 mmHg. We also found that combination therapies of PGA plus aqueous suppressants gave better outcomes compared with PGA alone. We found that revisionary SLT compared favourably with the first treatment, although first-time outcomes were not a good predictor of success with revisionary SLT. Primary and revisionary SLT has been shown to be effective across the cohort of patients in this study.

Brief Report on 12-Month Outcomes of the ab Interno Gel Stent Using the Intraoperative Posterior Sweep of Tenons (PoST) Technique

87 eyes of 70 patients (mean age 75.03 years) with an average 12-months follow-up underwent ab-interno Xen45 gel stent with PoST technique. Primary outcome: mean IOP change. Secondary outcomes: change in medications and complications. Preoperative mean IOP and medications were 18.66 mmHg and 3.36 respectively. At 12 months, mean IOP and medications were 13.1 mmHg and 1.35. Cumulative proportion of success (IOP less than 22 mmHg, ≥ 20% reduction in baseline IOP and no additional surgical intervention) was 0.72. Needling proportion was 9%. Cumulative proportion of reoperation was 0.22. The PoST technique resulted in significant reduction in IOP and medications.

The effectiveness and tolerability of fixed-dose combination netarsudil 0.02%/latanoprost 0.005% at a tertiary glaucoma center.

To assess real-world effectiveness and tolerability of fixed-dose combination netarsudil 0.02%/latanoprost 0.005% (FCNL) in management of glaucoma patients in a tertiary eye care center. This retrospective cohort study included glaucoma patients initiated on FCNL from January 2018 to July 2021 with at least 1-month follow-up. Demographic and clinical data were collected at baseline and at follow-up visits through 12months. Patient-solicited side effects were recorded at each visit. Maximum glaucoma pharmacotherapy was defined as surgery/laser being the next treatment option following an intensive pharmacotherapy regimen, or when pharmacotherapy could not be increased due to allergy/intolerance or all pharmacologic mechanisms already being in use. Seventy-nine eyes of 47 patients were included. Mean age was 67.7 ± 14.7years. Baseline IOP was 18.7 ± 4.9mmHg; mean change in IOP (∆IOP) each study visit compared to baseline ranged from - 1.6 ± 3.5 to - 4.4 ± 4.1mmHg (all p < 0.05). The eyes on maximum glaucoma pharmacotherapy (73.4%) had similar ∆IOP compared to those on non-maximal therapy at each visit (p > 0.2 for all). Forty-three (54.4%) eyes were switched from a prostaglandin analog alone, producing a 1-month IOP reduction of - 4.7 ± 3.9mmHg at 1month which remained significant at each visit for the 12-month study period (all p < 0.05). Across all study visits, conjunctival hyperemia was documented in 26 (32.9%) eyes. Subjective blurry vision was reported in 22 (27.8%) eyes without significant worsening of visual acuity at any visit (all p > 0.05). Six (7.6%) and 7 (8.9%) eyes required further medical or surgical/laser intervention, respectively. Kaplan-Meier analysis revealed no significant difference in the need for subsequent medical or surgical intervention between those on maximum and non-maximal pharmacotherapy (p > 0.4). FCNL was well-tolerated and demonstrated a significant and sustained reduction in IOP, even as last-line therapy before incisional or laser surgery in those on maximum glaucoma pharmacotherapy. FCNL is a viable treatment option for glaucomatous eyes before consideration of surgical intervention.

Effectiveness of trans-scleral cyclophotocoagulation for refractory paediatric glaucoma

Background: The aim of this study was to find out the effectiveness of trans-scleral cyclophotocoagulation in lowering intraocular pressure in the paediatric population.Patients and methods: This quasi-experimental study was conducted between July 2020 and January 2021 in Department of Ophthalmology, The Children’s Hospital, Lahore. Total 45 eyes of 42 children of age 1-14 years, both genders, with glaucoma were enrolled in this study. Diode cyclophotocoagulation unit and probe of make Quantel Medical was used for cycloablation under general anesthesia. Postoperative intraocular pressure was noted by using handheld Perkins applanation tonometer Mk2 after every 3 weeks for 12 weeks. If an IOP of ≤21mmHg was achieved, then efficacy or success was labeled. Patients with an IOP of &gt;21mmHg after 12 weeks were selected for repeat cycloablation treatment. Failure was labeled to an IOP of &gt;21mmHg even after a repeat session. Data analysis was done using SPSS 24. Results: In this study, 45 eyes were included with a mean age of 4.49 ± 3.12 years. There were 21 (46.7%) males and 24 (53.3%) females. At the time of presentation, the most common diagnosis was primary congenital glaucoma [28 (62.2%)], followed by aphakic glaucoma [10 (22%)], Anterior segment dysgenesis [2 (4.4%)], Pseudophakic glaucoma [2 (4.4%)], Sturge weber syndrome [2 (4.4%)] and Post-traumatic [1 (2.2%)]. The mean IOP at baseline was 26.67±3.66 mmHg, which was reduced to 19.60±6.33 mmHg with mean change in IOP of 7.07±4.56 mmHg (p&lt;0.05). The mean anti-glaucoma drugs used at baseline was 2.91±0.42, which was reduced to 0.93±1.2 with mean change in use of anti-glaucoma drugs of 1.98±1.06 (p&lt;0.05). Success was achieved in 34 (75.56%) eyes, while 11 (24.44%) needed second session. After repeat session 2 (4.4%) eyes went into treatment failure.Conclusion: Diode cyclophotocoagulation is a useful therapy for the management of glaucoma in children.

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

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

Treatment of open angle glaucoma or ocular hypertension with preservative‐free tafluprost/timolol fixed dose combination in a real‐world setting: analysis by diagnostic sub‐group at study entry

AbstractPurposeThe VISIONARY study assessed the efficacy of the preservative‐free tafluprost/timolol fixed‐dose combination (PF tafluprost/timolol FC) in patients with open‐angle glaucoma (OAG) or ocular hypertension (OHT) who were inadequately controlled with prostaglandin analogue (PGA) or beta‐blocker (BB) monotherapy. This analysis examined IOP reduction by diagnosis and prior treatment type.MethodsIOP was recorded at baseline for adults (≥18 years) receiving topical PGA or BB monotherapy for OAG/OHT and treatment was switched to PF tafluprost/timolol FC. IOP was recorded at Weeks 4, 12 and 24. The primary endpoint was mean absolute change in IOP from baseline at Month 6. Baseline diagnoses were OHT (n = 110), primary open‐angle glaucoma (POAG; n = 425), normal tension glaucoma (NTG; n = 13), or pseudoexfoliative glaucoma (PEX; n = 19).ResultsMean (SD) baseline IOP was 21.5 (5.00) mmHg, 22.3 (4.30) mmHg, 17.2 (2.68) mmHg and 21.7 (4.13) mmHg for patients with POAG, OHT, NTG and PEX, respectively. Respective Month 6 relative IOP reductions were 25.4%, 26.1%, 15.8% and 17.6%. Mean (SD) baseline IOP was 21.9 (4.36) mmHg and 21.4 (4.48) mmHg for BB and PGA users, respectively. Month 6 respective IOP reduction from baseline was 6.6 (4.16) mmHg (28.5%) and 5.4 (4.04) mmHg (23.6%) (p &lt; 0.0001). PF tafluprost/timolol FC was generally well tolerated; 14 patients discontinued due to poor local tolerance or insufficient IOP control.ConclusionsIn this real‐world study, PF tafluprost/timolol FC was effective and well‐tolerated in patients previously uncontrolled on BB or PGA monotherapy, irrespective of initial diagnosis and type of previous topical medication. Patients with OHT, POAG, NTG and PEX showed IOP reductions at Week 4 that were maintained throughout the study period.BibliographyOddone F, et al. Treatment of Open‐Angle Glaucoma and Ocular Hypertension with Preservative‐Free Tafluprost/Timolol Fixed‐Dose Combination Therapy: The VISIONARY Study. Adv Ther.2020;37(4):1436–51.

Treatment of open angle glaucoma or ocular hypertension with preservative‐free tafluprost/timolol fixed dose combination in a real‐world clinical practice setting: a cross‐country subanalysis

AbstractPurposeThe VISIONARY study assessed, in a real‐world clinical practice setting, the efficacy of preservative‐free tafluprost/timolol fixed‐dose combination (PF tafluprost/timolol FC) in adults with open‐angle glaucoma (OAG) or ocular hypertension (OHT) who did not achieve an adequate response to initial prostaglandin (PGA) or beta‐blocker (BB) monotherapy. This analysis examined the results reported by 7 countries (Italy, Hungary, Spain, Russia, UK, Latvia and Norway) enrolling &gt;10 patients.MethodsBaseline measurements of IOP were recorded in adults (≥18 years) receiving topical PGA or BB monotherapy for OAG/OHT and treatment was switched to PF tafluprost/timolol FC. IOP was measured at Weeks 4, 12 and 24 during routine ophthalmology visits. The primary endpoint was mean absolute change in IOP from baseline at Month 6, post‐treatment switch. Secondary endpoints included adverse event (AE) reporting and tolerability.ResultsChange in the mean IOP from baseline at Month 6 was 5.7 mmHg (24.9% reduction) for the overall population. Percentage reduction in IOP for the individual countries ranged from 22.3–31.8%. A statistically significant reduction in IOP from baseline was observed at all time points among patients from all countries. The highest percentage reduction in IOP was seen in Latvia at Month 6 (31.8%). Patient‐assessed tolerability was very good/good in 94% of patients. Most reported AEs were mild/moderate in severity and had resolved by the end of the study period.ConclusionsIn a real‐world clinical practice setting, PF tafluprost/timolol FC provided effective and well‐tolerated treatment for OAG/OHT patients insufficiently controlled on BB or PGA monotherapy. Results were consistent across all countries included in the study.BibliographyOddone F, et al. Treatment of Open‐Angle Glaucoma and Ocular Hypertension with Preservative‐Free Tafluprost/Timolol Fixed‐Dose Combination Therapy: The VISIONARY Study. Adv Ther.2020;37(4):1436‐51

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

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

Comparison of the Intraocular Pressure-Lowering Effect and Safety of Preservative-Free And Preservative-Containing Brimonidine/Timolol Fixed-Combination Ophthalmic Solutions in Patients with Open-Angle Glaucoma

ABSTRACT Purpose: To compare the therapeutic efficacy and safety of newly developed preservative-free (PF) brimonidine/timolol fixed-combination (BTFC) ophthalmic solutions and a preservative-containing (PC) BTFC ophthalmic solution in patients with open-angle glaucoma. Methods: This study was conducted as a multicenter, randomized, open-label, parallel-group clinical trial to evaluate the efficacy and safety of PF BTFC as compared with PC BTFC in adult patients (aged ≥ 19 years) with open-angle glaucoma (OAG) and ocular hypertension (OHT). A total of the 106 patients were enrolled, with 53 patients each randomized to the two treatment groups and included in the analysis of the safety set (SS). After a washout period, patients with an IOP below 35 mmHg at 9 a.m. were enrolled. After a full ophthalmic and glaucoma examination, a total of 106 OAG and OHT patients were randomized to the PF group or PC group. All subjects were examined 4 and 12 weeks after first administration. At each follow-up visit, IOP was measured at 9 a.m. and 11 a.m. and the efficacy, safety, and compliance were evaluated. Throughout the study, all adverse events were recorded and monitored by the investigators. Results The mean IOP changes from baseline to 12 weeks at 11:00 a.m. were −3.45 ± 2.53 mmHg in the PF group and −3.65 ± 2.76 mmHg in the PC group (p < .0001 for both). The difference in mean IOP change between the two groups was 0.20 ± 2.65 mmHg, which was not significantly different. The proportion of patients with IOP reductions of ≥ 15% and ≥ 20% and IOP at all-time points in the PF group were not significantly different when compared with in the PC group. There were no specific differences between the two groups regarding the incidence of adverse events. Conclusions PF BTFC ophthalmic solution shows a similar efficacy and safety profile to that of PC BTFC.

Intraocular pressure-lowering effects of ripasudil in uveitic glaucoma, exfoliation glaucoma, and steroid-induced glaucoma patients: ROCK-S, a multicentre historical cohort study

To evaluate the efficacy and safety of ripasudil for treatment of secondary glaucoma, a historical cohort study was conducted at 18 centres in Japan. Adults (age ≥20 years) who needed additional IOP reduction and received topical 0.4% ripasudil between 2014 and 2018 due to three secondary glaucoma subtypes, including uveitic glaucoma (UG), exfoliation glaucoma (EG) or steroid-induced glaucoma (SG) were assessed for mean IOP change from baseline prior to additional treatment with ripasudil. We further evaluated the IOP change in each glaucoma subtype, baseline characteristics of each cohort, course of uveitis-induced inflammation in UG eyes, and proportion of patients in each cohort with adverse events. In 332 eyes from 332 patients eligible for this study, the mean overall IOP reductions from baseline at 1, 3, and 6 months were −5.86 ± 9.04 mmHg (−19.4 ± 25.1%), −6.18 ± 9.03 mmHg (−20.0 ± 27.1%), and −7.00 ± 8.60 mmHg (−23.4 ± 25.6%), respectively. These changes were all statistically significant. Of 332 eyes, 109 eyes had UG, 181 had EG, and 42 eyes had SG. The IOP-lowering effects of ripasudil in UG and SG were significantly greater than those of EG at every time point. This finding could have been related to higher baseline IOP levels in UG and SG. UG patients exhibited significant decreases in mean cell score of the anterior segment after ripasudil treatment. No severe adverse events were reported. These findings suggest that treatment with ripasudil is a safe and effective therapeutic modality for IOP reduction in secondary glaucoma.

Safety and efficacy outcomes of the Xen45 Gel Stent use for refractory glaucoma: a surgery series from surgeon trainees at a tertiary teaching hospital

BackgroundTo study the effect of an ab interno gelatin stent (XEN45 Gel Stent, Allergan Inc., Irvine, California, USA) on intraocular pressure (IOP) as placed by glaucoma fellowship trainees in eyes with refractory glaucoma.MethodsA prospective noncomparative study at a tertiary training center on 28 unique eyes undergoing ab interno gelatin stent implantation by glaucoma fellowship trainees. Data was collected at baseline and postoperatively at day 1, week 1, and months 1, 3, 5, and 12. Primary outcome was mean IOP change. Secondary outcomes included change in number of glaucoma medication classes and visual acuity. Safety outcomes included needling rates. Surgical success was defined by achieving ≥20% reduction in IOP with the same or fewer classes of antiglaucoma medications from baseline without the need for secondary surgical intervention and/or stent removal.ResultsAt baseline, 28.6% (8/28) of the subjects had prior failed incisional glaucoma surgery in a study population that was 54% African-American, with 78% with severe glaucoma (average mean deviation of − 14.58 dB). Thirteen subjects terminated their clinic visits before their 12-month postoperative visit, leaving 15 subjects for end point analysis. Average IOP went from 21.6 mmHg (range 12.0–31.0, SD 6.6) at baseline to 12.5 mmHg (range 7.0–19.0, SD 3.6), a 42.1% reduction (p < 0.007). All subjects decreased the number of medication classes they were taking with an average reduction of 3.8 (range 2–5, SD 0.9) to 1.3 (range 0–3, SD 1.0) classes, or a 65.8% decrease (p < 0.006). Crude surgical success was 80.0% for the 15 subjects that followed up at 12 months. The Kaplan-Meier cumulative probability of success for all 28 subjects at 12 months was 70.4% (95% CI: 44.7–85.8%). Regardless of the length of follow-up, 21.4% (6/28) met failure criteria: 3 subjects failed because they required secondary surgical intervention, and the other 3 did not have adequate IOP reduction. Initial bleb needling rate was 28.6% (8/28) and repeat was 17.9% (5/28).ConclusionsCompared to the reported literature with experienced ocular surgeons, ab interno gel stent placements by glaucoma fellowship trainees have similar mean IOP, topical medication reduction, surgical success, and needling rates at 12-month follow-up.

Preservative-free fixed combination in the treatment of open-angle glaucoma and ocular hypertension: the VISIONARY Study (EUPAS22204)

To evaluate efficacy, tolerability, and safety of PF tafluprost/timolol FC in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OH) who couldn't tolerate or gave insufficient response to topical beta-adrenoblockers or prostaglandin analogue monotherapy. The prospective multicenter European VISIONARY study (EUPAS22204) included 87 patients from 7 ophthalmological centers in Russia with mean age of 63.9±11.8. Primary endpoint was mean IOP change at month 6. The patients were monitored for changes in in the severity of ocular signs and symptoms. Statistically significant (p<0.0001) reduction of mean IOP from baseline was seen at all study visits: 7.3±5.17 mmHg at week 4, 7.4±5.40 mmHg at week 12, and 7.1±5.10 mmHg at month 6. By month 6, IOP has decreased by 20; 25; 30 and 35% from baseline in 77.0%, 58.9%, 43.7%, and 31.0% of study patients, respectively. Conjunctival hyperemia was significantly reduced at all study visits. Significant reductions in dry eye symptoms (p<0.0010), irritation (p=0.0204) and itching (p=0.0010) were also observed. After 6 months on PF tafluprost/timolol FC, 85.7% of patients described it as easy or very easy to tolerate. In clinical practice, PF tafluprost/timolol FC provided statistically significant IOP reductions in patients with POAG and OH insufficiently controlled by or intolerant to monotherapy with topical beta-adrenoblockers or a prostaglandin analogue. The highest IOP reduction was seen at week 4 and was maintained over the 6-month study period. There was also a decrease in the severity of symptoms of ocular surface condition.

The Outcomes of Switching from Short- to Long-Term Intravitreal Corticosteroid Implant Therapy in Patients with Diabetic Macular Edema

Background: First-line treatment for diabetic macular edema (DME) is usually with antivascular endothelial growth factor agents, followed by intravitreal corticosteroids as a second-line treatment option. Long-term corticosteroids may offer quality of life and effectiveness benefits over short-term implants. Objectives: To evaluate outcomes of patients with persistent or recurrent DME who switched from a short-term (dexamethasone) to a long-term (fluocinolone acetonide, FAc) corticosteroid intravitreal implant in a real-world setting. Methods: This is a retrospective study in 9 Portuguese centers. An FAc intravitreal implant was administered according to product labeling. Effectiveness outcomes were mean change in visual acuity (VA; ETDRS letters), central retinal thickness (CRT; µm), and macular volume (MV; mm³). The safety outcome was mean change in intraocular pressure (IOP; mm Hg). All were analyzed at months 1 and 3, and then quarterly until month 24 after implantation. Results: Forty-four eyes from 36 patients were analyzed. Mean duration of DME was 3.3 ± 1.9 years, and mean follow-up was 8 months. From baseline following FAc implantation, VA increased significantly at months 1 and 6 (mean +6.82 and +13.02 letters, respectively; p = 0.005), and last observation carried forward (LOCF; mean +8.3 letters; p = 0.002). CRT improved significantly at months 1 and 6 (mean –71.81 and –170.77 µm, respectively; p = 0.001), and LOCF (mean –121.46 µm; p = 0.001). MV was consistently, but not significantly, decreased from baseline to LOCF (mean –0.69 mm³; p = 0.062). The mean change in IOP was –0.25 and +0.88 mm Hg at months 1 and 6, respectively (p = 0.268), and +1.86 mm Hg at LOCF (p = 0.036). Increases were controlled with topical medication in most cases. Conclusions: The FAc intravitreal implant is effective in patients previously treated with short-term corticosteroid implants. Thus, after a suboptimal response to antiangiogenics or a short-term corticosteroid, a single FAc implant may be considered an effective and tolerable treatment that can improve long-term outcomes for patients with sight-threatening DME.

Efficacy and safety of tafluprost 0.0015% - retrospective analysis of real-world data from the Philippines.

PurposeTo investigate the IOP lowering effect and safety of tafluprost 0.0015% in a routine clinical setting in the Philippines.Patients and methodsA retrospective review of glaucoma patients receiving tafluprost 0.0015% (BAK 0.001% preserved) with a minimum follow-up of 3 months was conducted. Main outcome measure was the mean IOP change at month 3. Secondary outcome measures included longitudinal IOP assessments and occurrence of any adverse events.ResultsThree-hundred twenty-nine eyes of 177 patients with mean age 64.8 years were included and followed for mean 8.8 months. Most common diagnosis was primary open-angle glaucoma (POAG) (34.9%), followed by primary angle-closure (PAC) glaucoma post-laser iridotomy (24.0%), PAC post-laser iridotomy (15.5%), ocular hypertension (OHT)(14.6%), secondary glaucoma (6.7%), and normal-tension glaucoma (4.3%). Mean IOP change at month 3 was −6.18 mmHg (SD 4.06), a −26.37% reduction (p<0.001) and IOP reduction was sustained throughout the study period (p<0.001). Sub-group analysis of treatment naïve (n=203); add-on (n=53) and replacement therapy (n=73) showed a 3-month mean IOP reduction of −8.34 mmHg (SD 2.57, p<0.001) or –31.24%, −5.08 mmHg (SD 2.86, p<0.001) or –23.68%, and −1.00 mmHg (SD 3.08; p=0.007) or –6.31%, respectively. There was significant IOP reduction from baseline in both POAG/OHT sub-group and the PAC/PACG post-laser iridotomy with ≥90° open-angle sub-group (p<0.001), sustained up to month 12 post-treatment. However, there was no significant difference in the average absolute (mmHg) or proportional IOP change from baseline between the two sub-groups. Conjunctival hyperemia was the most common adverse reaction occurring in 15% of patients.ConclusionTafluprost was a safe and effective IOP-lowering treatment in this routine clinical setting.

INTRAOCULAR PRESSURE;

Objectives: To determine mean changes in intraocular pressure after intra-vitreal bevacizumab (anti vascular endothelial growth factor) in non-glaucomatous patients suffering from retinal vascular disorders. Study Design: Quasi experimental study. Setting: Outdoor patient Department of Layton Rahmatullah Benevolent Trust Free Eye Hospital, Lahore. Period: 06 months from Jan-2017 to June-2017. Patients and Methods: A total number of 100 patients having age 18-65 years who presented with retinal vascular disorders. Pre injection intraocular pressure was measured with Goldman Applanation Tonometer five minutes before injection. After that intravitreal bevacizumab was injected using standardized technique. Post-injection, intraocular pressure was measured after 1 month of injection. Data was analyzed with the help of SPSS v19. Paired sample t-test was applied to determine any significant difference in pre-injection and post-injection IOP at p-value of &lt;0.05. Mean change in IOP was also calculated. Results: Mean age of patients was 51.76+9.22 Years. There were 50% male patients and 50% female patients. Diabetic retinopathy was diagnosed in 41% patients, central serous chorio-retinopathy in 17%, age related macular degeneration in 16%, branch retinal venous occlusion in 15% and idiopathic choroidal neovascularization in 11% patients. Right sided eye was affected in 53% patients. Mean pre-injection IOP was 14.07+3.15 and mean post-injection IOP was 14.54+2.31 mmHg (p-value 0.12). Mean difference in pre-injection and post-injection IOP (after 1 month of injection) was -0.523+2.98 mmHg. Conclusion: Bevacizumab can be safely administered for the treatment of non-glaucomatous retinal vascular disorders without significantly disturbing the IOP for a longer period of time.

Outcome of phacoemulsification combined with excisional goniotomy using the Kahook Dual Blade in severe glaucoma patients at 6 months.

PurposeThe aim of this study was to describe 6-month rates of achieving target IOP without requiring additional glaucoma surgery after excisional goniotomy using the Kahook Dual Blade combined with phacoemulsification (phaco-KDB) in patients with severe-stage glaucoma.MethodsRetrospective review of 42 eyes from 36 patients with severe glaucoma who received phaco-KDB. Primary and secondary open-angle and combined-mechanism glaucoma were included. Preoperative, intraoperative, and postoperative data were collected through the 6-month follow-up period. The primary outcome was proportion of patients achieving IOP ≤15 mmHg without additional glaucoma procedures. Secondary outcomes were mean change in IOP, reduction of glaucoma medications, additional glaucoma procedures needed, and adverse events.ResultsPreoperative baseline mean IOP was 17.1±4.8 mmHg (mean ± SD) and number of medications was 2.4±1.3. At 6 months, 64.3% (27/42) of eyes had achieved IOP ≤15 mmHg without additional glaucoma procedures, 45.2% (19/42) reached this target IOP on fewer medications, and 31.0% (13/42) on no medications. Mean IOP reduction was 2.1±4.67 mmHg (P=0.022) and mean medication reduction was 1.2±1.4 (P≤0.001). Visually significant complications were experienced by 7.1% (3/42) of eyes, and 7.1% (3/42) required additional IOP-lowering procedures within 6 months of surgery.ConclusionPatients with severe-stage open-angle glaucoma achieved significant IOP and medication reductions following phaco-KDB. Notably, about two-thirds of eyes achieved an IOP of ≤15 mmHg at 6 months without additional glaucoma procedures. Complications and need for additional procedures were rare. Phaco-KDB may be an effective and safe alternative to more invasive filtering surgery in many patients with severe glaucoma.

Prediction of Visual Field Progression in Patients with Primary Open-Angle Glaucoma, Mainly Including Normal Tension Glaucoma

An objective method to predict individual visual field progression will contribute to realise personalised medication. The purpose of this study was to establish a predictive formula for glaucomatous visual field progression in patients with Primary open-angle glaucoma, mainly including normal tension glaucoma. This study was a large-scale, longitudinal and retrospective study including 498 eyes of 312 patients visiting from June 2009 to May 2015. In this analysis, 191 eyes of 191 patients meeting all eligible criteria were used. A predictive formula to calculate the rate of glaucomatous visual field progression (mean deviation slope) was obtained through multivariate linear regression analysis by adopting “Angle of Retinal Nerve Fibre Layer Defect” at the baseline, “Vertical Cup-Disc ratio” at the baseline, “Presence or absence of Disc Haemorrhage” during the follow-up period, and “Mean IOP change (%)” during the follow-up period as predictors. Coefficient of determination of the formula was 0.20. The discriminative ability of the formula was evaluated as moderate performance using receiver operating characteristic analysis, and the area under the curve was approximately 0.75 at all cut-off values. Internal validity was confirmed by bootstrapping. The predictive formula established by this type of approach might be useful for personalised medication.

Efficacy of 0.2\u2009\u03bcg/day fluocinolone acetonide implant (ILUVIEN) in eyes with diabetic macular edema and prior vitrectomy

PurposeLimited data are available on the efficacy of the 0.2 μg/day fluocinolone acetonide (FAc) implant in eyes with prior vitrectomy. Here, we present a collection of 26 vitrectomized eyes treated with the 0.2 μg/day FAc implant.MethodsRetrospective study involving six centers from four European countries analyzing the safety and efficacy data from patients (26 eyes from 25 patients) with DME and a prior vitrectomy that had been treated with one 0.2 μg/day FAc implant.ResultsPrior intravitreal therapies included anti-VEGF (mean, 3.8 injections) and steroids (mean, 1.9 injections). Pars plana vitrectomy (PPV) was performed in these eyes primarily for abnormalities of vitreoretinal interface, followed by proliferative diabetic retinopathy and vitreous hemorrhage. The 0.2 μg/day FAc implant was injected 24.2 months, on average, after PPV and the mean duration of follow-up after injection was 255 days (range, 90 to 759 days). The mean change in BCVA was +11.7 ETDRS letters (range, −19 to +40 letters; P<0.0004) and the mean change in central foveal thickness (CFT) was −233.5 μm (range, −678 to 274 μm; P<0.0001). The mean change in IOP from baseline at the last visit was +1.4 mm Hg (range, −9 to +8 mm Hg; P=0.0090). Eight eyes initiated or continued IOP lowering medications.ConclusionsThese data suggest the 0.2 μg/day FAc implant is effective in vitrectomized patients with an acceptable safety profile. Further studies are still required to confirm the current findings and to assess the effect of the 0.2 μg/day FAc implant over a longer period of follow-up.

Randomized, Double-Masked, Placebo-Controlled Study to Assess the Ocular Safety of Mirabegron in Healthy Volunteers

This study assessed the effect of mirabegron on ocular safety in healthy volunteers. This was an 8-week, randomized, double-masked, placebo-controlled study. Consenting adults aged ≥18 years with a normal intraocular pressure (IOP, ≥10 to ≤21 mmHg) were eligible to enter the study. Of the 321 randomized subjects, 305 completed the study. Subjects were randomized 1:1 to a supratherapeutic dose of oral mirabegron 100 mg or placebo once daily for 56 days. The IOP was measured at screening, baseline, day 10, and day 56/end of treatment using Goldmann applanation tonometry. Visual acuity and biomicroscopy were also evaluated. The primary endpoint was the mean change from baseline in the IOP at 56 days or end of treatment with mirabegron versus placebo. Secondary outcome variables included change from baseline to day 10 in the IOP, and increases in the IOP of ≥6 mmHg and ≥10 mmHg in either eye from baseline to day 10 and day 56. The mean (standard error, SE) IOP at baseline was 15.3 (0.16) mmHg for mirabegron and 15.4 (0.16) mmHg for placebo; values at day 56 were 15.0 (0.16) mmHg and 15.2 (0.17) mmHg, respectively. The adjusted mean IOP change from baseline to day 56 was -0.3 mmHg for mirabegron and -0.2 mmHg for placebo (-0.1 mmHg difference [95% confidence interval, CI, -0.4 to 0.3]). For the primary endpoint, mirabegron was noninferior to placebo, based on the prespecified limit of 1.5 mmHg. No statistically significant treatment effects on the IOP were seen at day 10. No subject discontinued due to increased IOP. Clinically significant increases from baseline in the IOP occurred rarely and only with placebo treatment. Changes in the visual acuity and biomicroscopy were not suggestive of a mirabegron effect. No treatment-emergent adverse event (AE) of glaucoma was reported. Mirabegron 100 mg orally once daily for 8 weeks of treatment does not increase the IOP, and was generally safe and well tolerated.

Outcome of 23-gauge sutureless transconjunctival vitrectomy for endophthalmitis

To review the outcomes of 23-gauge transconjunctival vitrectomy in patients with postoperative endophthalmitis. Non-randomized, interventional case series of patients with postoperative endophthalmitis over a 1-year period. 23-gauge transconjunctival vitrectomy was performed on 6 patients with a mean age of 67.7 years without intraoperative or postoperative complications. There were no cases of postoperative hypotony or wound leak. The mean change in IOP was -4.2 mmHg compared to the preoperative IOP (P=0.239). Final VA improved significantly compared to preoperative VA (P=0.062), with VA of at least 20/40 in 5 of 6 patients (83.3%). 23-gauge transconjunctival vitrectomy is a useful technique for treating postoperative endophthalmitis.