Narrow-angle Glaucoma Research Articles

Leksell Radiosurgery for Orbital, Uveal, and Choroidal Tumors.

Stereotactic radiosurgery using the Leksell Gamma Knife has proven to be a valuable alternative to orbital enucleation or fractionated radiation therapy for primary tumors of the orbit, metastatic tumors to the choroid, and primary uveal melanomas. With this approach in a single outpatient setting, the eye is immobilized by a local block after which high-definition MRI or CT is performed to define the target. After rapid dose planning, radiation delivery is completed before the local block dissipates. The tumor response is often dramatic. The risk of acute narrow-angle glaucoma, radiation-related retinopathy, or cataract formation has been relatively low. Other worldwide centers have confirmed that this approach is superior to either enucleation or fractionated radiation therapy for these relatively rare problems.

Association of Angle Width With Progression of Normal-Tension Glaucoma

Glaucoma has been dichotomically classified as open or closed angle, and accordingly, distinct therapies have been administered. In this study, the issue of narrow-angle normal-tension glaucoma (NTG), which may be an intermediate-stage or hybrid-stage disease entity, was addressed. To determine whether anterior chamber (AC) angle width plays any role in NTG progression. Retrospective analysis of prospectively collected data at Seoul National University Hospital between January 2004 and December 2009. Fifty-two eyes of narrow-angle NTG and 52 wide-angle NTG eyes matched for age, untreated intraocular pressure, and mean deviation of visual field. Nonindentation gonioscopy was used to grade AC angles: narrow angle was defined as a partially invisible (invisible in ≥90° and <180°) pigmented posterior trabecular meshwork, and wide angle was defined as a fully visible pigmented posterior trabecular meshwork. Data were analyzed in September 2017. Optic disc/retinal nerve fiber layer defect and visual field progression. Of the narrow-angle NTG cohort, the mean (SD) age was 49.5 (9.1) years and 15 individuals (28.8%) were women; of the wide-angle NTG cohort, the mean (SD) age was 48.7 (9.5) years and 19 (36.5%) were women. All participants were Korean. Over the course of the mean (SD) 7.6 (0.4)-year follow-up period, 25 of 52 narrow-angle eyes (48.1%) and 13 of 52 wide-angle eyes (25.0%) showed structural progression (odds ratio [OR], 2.78; 95% CI, 1.21-6.37; P = .02). Meanwhile, 21 of 52 narrow-angle eyes (40.3%) and 9 of 52 wide-angle eyes (17.3%) showed functional progression (OR, 3.24; 95% CI, 1.31-8.00; P = .009). The cumulative probability of both structural and functional progression was significantly greater in the narrow-angle than in the wide-angle group (mean [SD] 5-year survival rates, 0.56 [0.07] vs 0.83 [0.05]; P = .006 and 0.60 [0.07] vs 0.87 [0.05]; P = .007, respectively). The baseline diurnal intraocular pressure's SD was approximately 1.38-times greater in the narrow-angle than in the wide-angle group (1.8 [0.6] vs 1.3 [0.3] mm Hg; mean difference, 0.52; 95% CI, 0.32-0.72; P < .001). For the follow-up intraocular pressure fluctuation, the narrow-angle group showed an approximately 1.75-times greater SD (2.1 [0.5] vs 1.2 [0.3] mm Hg; mean difference, 0.93; 95% CI, 0.77-1.09; P < .001). Narrow-angle NTG showed a greater probability of disease progression than did wide-angle NTG. Further studies determining whether augmented or differentiated treatment strategies would be beneficial for patients with narrow-angle NTG are warranted.

Role of Phacoemulsification versus Phacotrabeculectomy on IOP in Patients with Primary Narrow Angle Glaucoma

Role of Phacoemulsification versus Phacotrabeculectomy on IOP in Patients with Primary Narrow Angle Glaucoma

Prophylactic anterior vitrectomy during cataract surgery in eyes at increased risk for aqueous misdirection

PurposePatients with chronic narrow angle glaucoma (CNAG) are at increased risk of developing aqueous misdirection (AM) following intraocular surgery. We present a retrospective case series on the use of posterior capsulorrhexis with core vitrectomy by an anterior approach (CAV) at the time of cataract extraction with or without glaucoma surgery as a prophylactic measure for the prevention of AM in CNAG. MethodsRetrospective case series of six phakic eyes in four patients with CNAG and other risk factors for AM who underwent posterior capsulorrhexis and CAV at the time of cataract surgery with or without glaucoma surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and post-operative complications. ResultsSix eyes in four subjects underwent posterior capsulorrhexis with CAV at the time of cataract surgery. The case was combined with incisional glaucoma surgery in the five eyes with advanced visual field loss. The mean logMAR BCVA and IOP improved from 0.554 ± 0.398 and 25.2 ± 13 mmHg, respectively, at the pre-operative visit to 0.257 ± 0.218 and 12.2 ± 1.7 mmHg, respectively, at final follow-up. Both eyes with nanophthalmos developed non-appositional serous choroidals that resolved with atropine, but the left eye required additional treatment with synechiolysis, intraocular lens repositioning, limited AV and endocyclophotocoagulation. There were no permanent, vision-threatening complications. Conclusions and importanceCAV can be safely combined with cataract surgery and glaucoma surgery, and it may be an effective intervention in eyes with CNAG and other risk factors for AM as a prophylactic measure against the development of AM.

Efficacy of Cataract Surgery With Trabecular Microbypass Stent Implantation in Combined-Mechanism Angle Closure Glaucoma Patients

To evaluate the effectiveness of trabecular microbypass stent (iStent) implantation in combined mechanism glaucoma (CMG). Retrospective cohort study. We reviewed the medical charts of patients with the following scenarios: (1) primary open-angle glaucoma (POAG) undergoing phacoemulsification (PE), (2) POAG undergoing PE with iStent (POAG-PE/iStent), (3) CMG undergoing PE (CMG-PE), and (4) CMG undergoing PE with iStent (CMG-PE/iStent). CMG was defined as narrow-angle glaucoma patients whose angle had opened after iridotomy. Linear mixed-effects models were performed to determine the effect of iStent on postoperative 1-year success rate (intraocular pressure [IOP] ≤ 18 without medication), IOP, and number of medications. Data from 301 eyes were available. The number of eyes (subjects) was 61 (45) in the POAG-PE, 60 (50) in POAG-PE/iStent, 93 (76) in CMG-PE, and 87 (70) in CMG-PE/iStent group. Success criteria were achieved in 13.1% for POAG-PE, 33.3% for POAG-PE/iStent (POAG-PE vs POAG-PE/iStent B 3.01; P < .001), 37.6% for CMG-PE, and 43.7% for CMG-PE/iStent (CMG-PE vs CMG-PE/iStent B 2.25; P < .001). There was no difference in the IOP between POAG-PE and POAG-PE/iStent, and between CMG-PE and CMG-PE/iStent. The iStent significantly reduced number of medications in the POAG (B-0.70; P<.001) and CMG group (B-0.52; P < .001). Comparing the effect of iStent on POAG and CMG, the analysis showed similar iStent efficacy in terms of the success rate, IOP, and number of medications (P > .05). Combined PE/iStent significantly increased success rate and reduced number of medications in CMG patients compared to PE alone. The effects of iStent were comparable between POAG and CMG groups.

Комбинированный метод лазерного лечения первичной узкоугольной (смешанной) глаукомы

Purpose. To study the efficiency of a combined method for laser treatment – the laser iridectomy in combination with the selective laser trabeculoplasty (LIE+SLTP) – in patients with primary narrow-angle (mixed) glaucoma. Material and methods . The study included 72 patients (72 eyes) with initial stage of primary narrow-angle (mixed) glaucoma. The average age of the patients was 65.1±6.56 years: 27 males, 43 females. The followup period was up to 4 years after laser treatment. The level of intraocular pressure (Р 0 ) before the treatment was on average 24.47±1.85mmHg. The mean quantity of antihypertensive drugs used by the patients before the laser operation was 2.2±0.4. Stages of the combined treatment: laser iridectomy and selective laser trabeculoplasty were performed immediately one after the other in all patients. Results. All laser interventions were carried out without complications.An extension of the anterior chamber angle (ACA) was achieved in all patients, which was confirmed by data of gonioscopy and anterior optical coherence tomography (OCT). On the 1st day after the combined laser treatment, the reactive elevation of IOP was observed in 9.7% of cases and was stopped by an additional antihypertensive therapy within 1-2 days. Other complications such as inflammatory, hemorrhagic were not detected. A week after laser treatment there was a significant decrease (p<0.05) of intraocular pressure (IOP) by 6.9mmHg on average (28.2%) of the original. In the long-term postoperative follow-up period, the average decrease of IOP was 23.4%. Ophthalmotonus normalization occurred with increasing the coefficient of aqueous humor outflow facility (C) from 0.09±0.01 to 0.18±0.01 (p<0.05). In the long-term postoperative follow-up the IOP normalization was achieved in 87.5% of cases (63 eyes of 72). The IOP decrease to normal occurred in 9 eyes after the repeated SLT. The average number of antihypertensive agents that were used by the examined patients after the treatment decreased and averaged 1.02±0.1. The visual acuity remained unchanged in 80.5% of cases. The decrease of the vision was due to the progression of complicated cataract. Limits of peripheral visual field remained stable by the end of the follow-up period in 96% of cases. Within the observation period, according to computer perimetry data, negative dynamics was recorded in 6 patients (6 eyes out of 72 – 8.3%). According to HRT, negative dynamics in the form of a decrease in the volume of the neural rim, an increase in the area of the optic disc excavation was noted in 7% of cases (5 eyes of 72). Conclusion. The proposed method of combined laser treatment allows to achieve the IOP normalization due to an expansion of ACA after LIE with a subsequent activation of trabecula by SLT in 87.5% of patients. Ophthalmotonus normalization, stabilization of visual functions and indicators of the optic nerve conditions in the vast majority of patients in the long-term postoperative period proves the efficiency of the proposed technique in the treatment of patients with the initial stage of primary narrow-angle (mixed) glaucoma. The simultaneous operation of two stages – laser iridectomy and SLT is safely and enables significantly to reduce the duration of treatment and rehabilitation of patients.

Sport and Glaucoma

Traumatic changes in the iridocorneal angle, e.g. in ball sports, can lead to secondary glaucoma. High intensity resistance exercise or yoga exercises - such as the headstand - can increase IOP, and deterioration in the visual field and acute narrow angle glaucoma attacks have been described in some case reports. Glaucoma therapy of professional athletes with steroids, carbonic anhydrase inhibitors and beta-blockers can result in positive doping tests. In manifest glaucoma, moderate aerobic exercise is presumably of use because of the IOP lowering effect, improved retinal perfusion and reduction in oxidative stress.

Ophthalmology national normative database series (2): Gonioscopic character of the normal anterior chamber angle in sudanese adults

Background: The anterior chamber angle (ACA) is the anatomical angle bounded by the iris root and the peripheral corneal vault that comprises the aqueous outflow drains, namely the trabecular meshwork (TM) and the Schlemm's canal. The assessment of the ACA is used to classify glaucoma into open or narrow angle glaucoma's. Objective: The aim of this study is to determine the normal range values of the gonioscopic character of the ACA in adult Sudanese population and to define the effects of age, gender, and tribal ethnicity on these values. Materials and Methods: Three hundred ninety-eight eyes (n = 396); of 198 adults volunteers Sudanese healthy workers, from two factories in Khartoum, North district, were enrolled in this study; over a period of 3 months from January 1, 2009 to March 30, 2009. One hundred and sixty males 38 were females; aged ranged from 18 to 50 years. All participants underwent systematic static and dynamic gonioscopy by Posner Gonio lens in conjunction with Haag- Streit slit lamp. Then, the ACAs were graded according to Shaffer grading and classification system. The effect of age, gender and tribal ethnicity on ACA was analyzed. Then, the overall grading and TM Pigmentation analysis were done with special grading criteria specifically designed for this study (Manal–Saleem ACA Overall Grading System and Saleem-Manal TM Pigmentation Grading System). Results: In total, 198 (n = 198) Sudanese adults were recruited for the study with the mean age of the study group was 43 ± 16 years (range: 18–50 years). About 80.8% of males and 19.2% of females. 77.8% have open ACA and 19.2% narrow ACA, 0.5% closed ACA, and 2.5% with Creeping ACA. Open ACA is more in males (81.3%) than female (63.2%) while narrow ACA is more in female (34.2%) than male (15.6%). Closed and creeping ACA are similar in the two sexes. The effects of tribal ethnicity was not so profound as both the Arabs (84.1%) and Africans (87.5%) origin groups were showing minor differences in the high rate of open-angle (3.4% more in the African's) and narrow ACA (2.9% more in Arab's) apart from the Bejja groups, who recorded 100% narrow ACA while the Nubian groups of Far North recorded a lower percentage of the open ACA (78.6%) and higher of narrow ACA (17.9%). Narrow ACA was proved to be more with older age (25% as compared 10–12.5%). The TM Pigmentation in the younger age groups was found to be of lightly pigmented in 66.7% and heavily pigmented in 33.3%. A result which was affected by tribal ethnicity; 54.9% of Arab origin groups have lightly pigmented TM while 92.0% of African origin groups presented with heavily pigmented TM. In general, pigmentation was shown to be more heavily in the inferior quadrant rather than superior and horizontal quadrants. Conclusion: There is a higher rate of open ACA (77.8%) in Sudanese Adults with low rate (19.2%) of narrow ACA, followed by an even more lower rate of creeping ACA 2.5% and scarcely closed ACAs (0.5%). The average Sudanese ACA TM pigmentation is 35.4% being of light pigmentation and 64.6% of heavy pigmentation with highly significant tribal, age, and Quadrantic variations (P = 0.000).

Cataract extraction as primary treatment for narrow angle glaucoma

Cataract extraction as primary treatment for narrow angle glaucoma

Comparison between Ologen implant and different concentrations of Mitomycin C as an adjuvant to trabeculectomy surgery.

CONTEXT:Trabeculectomy is the most common surgical procedure for treatment of glaucoma. To improve success rates, adjuvants were utilized as Mitomycin C (MMC) and Ologen implant.AIMS:This study aims to establish efficacy and safety of Ologen implant versus MMC in trabeculectomy.SETTING AND DESIGN:A prospective, comparative clinical study was conducted at the Department of Ophthalmology, Assiut University, between December 2014 and April 2016.SUBJECTS AND METHODS:Patients with primary open-angle glaucoma (OAG), primary narrow-angle glaucoma and secondary OAG were assigned equally to trabeculectomy with Ologen, 0.4 mg/mL or 0.2 mg/mL MMC. The study outcome measures were reduction in intra-ocular pressure (IOP), success rates, survival analysis, and rate of complications.STATISTICAL ANALYSIS USED:SPSS software Version 17.0 (SPSS, Inc., IL, USA) was utilized.RESULTS:Thirty eyes were included in the study. Mean baseline IOP in Ologen, MMC 0.4 and MMC 0.2 groups were 27.43 ± 2.97, 28.4 ± 3.24, and 27.56 ± 2.69 mmHg, respectively. At week 24 follow-up, mean IOP in Ologen, MMC 0.4 and MMC 0.2 groups were 18.55 ± 3.18, 16.2 ± 3.22, and 16.93 ± 3.04 mmHg, respectively. No significant inter-group difference was noticed at any visits. Complete success was achieved in 10%, 40%, and 30%, whereas incomplete success in 70%, 50%, and 60%, respectively in Ologen, MMC 0.4 and MMC 0.2 groups. No treatment group difference was reported by Kaplan–Meier analysis. Shallow anterior chamber occurred more in Ologen and MMC 0.4 groups. A single case of serous choroidal effusion had occurred in MMC 0.4 group.CONCLUSION:Ologen implant is a promising alternative to MMC for improving the success rate of trabeculectomy.

Analysis of Glaucoma Subtypes and Corresponding Demographics in a New Zealand Population

Purpose: The aim of this paper was to determine the diagnosis distribution and demographic characteristics of glaucoma in a New Zealand population. Methods: The clinical records of all patients presenting consecutively to the Auckland District Health Board Glaucoma Service over a 6-month period were reviewed. Demographic parameters including ethnicity, age at presentation, and gender were collected along with all clinical data. Results: The case records of 857 patients were reviewed. Primary open-angle glaucoma (POAG) was the most common diagnosis (39.0%, n = 235), followed by primary-angle closure (PAC) diagnoses (24.8%, n = 149). This group was formed by the combination of narrow angle 18.1% (n = 109), narrow-angle glaucoma 0.3% (n = 2), PAC 2.1% (n = 13), and PAC glaucoma 4.2% (n = 25). Normal-tension glaucoma (NTG; 17.4%, n = 105), secondary glaucoma (SG; 11.5%, n = 69), ocular hypertension (5.0%, n = 30), and mixed mechanism (2.3%, n = 14) were also found. There was a significant difference in the ethnic distribution in the study population compared to the catchment population (p < 0.001). Caucasian and Indian ethnicities were overrepresented, whereas the Pacific Island Nation ethnicity was underrepresented in all groups except SG. The Maori ethnicity was underrepresented in all groups except PAC. The underrepresentation was most prominent in POAG (only 2 patients of Pacific origin and 1 Maori patient with POAG). Significant differences were identified in gender distribution including a higher preponderance of females in NTG and PAC. Significant differences in age at presentation were also identified between different glaucoma subtypes and ethnicities. Markers of glaucoma severity did not vary with respect to demographic characteristics. Conclusion: In a tertiary glaucoma service in New Zealand, Maori, Pacific peoples, and, to a lesser extent, Asians are underrepresented, while Caucasians and Indians are overrepresented in the glaucoma population.

Ocular safety of propiverine hydrochloride in elderly patients with primary open- and narrow-angle glaucoma .

Propiverine hydrochloride (P4) is an antimuscarinic drug used in overactive bladder syndrome. Two studies were performed: one in 24 patients with open-angle glaucoma (OAG) treated with topical β-blockers, one in 24 patients with narrow-angle glaucoma (NAG) treated with pilocarpine ± topical β-blockers. Patients were treated in randomized, placebo-controlled, double-blind parallel-group fashion (15:9 attribution to P4 vs. placebo (PL)). Single-blind PL dose in the morning of day 1 for baseline; double-blind 15 mg P4 or matched placebo t.i.d. from the afternoon of day 1 until the morning of day 7. In the morning of day 7, trough mean serum P4 concentrations were 169.4 ng/mL (CV (coefficient of variation): 0.55) and 140.7 ng/mL (CV: 0.56) in OAG and NAG; at 3:15 hours after dosing: 237.4 ng/mL (CV: 0.47) and 212.4 ng/mL P4 (CV: 0.38), respectively. P4-treatment led to a prompt (OAG) or more gradient (NAG) increase in pupil diameter (PUD), with a maximum difference from PL of 0.97 mm (95% confidence interval (CI): 0.67 - 1.27) and 0.87 mm (95% CI: 0.36 - 1.39) in OAG and NAG, respectively. However, there was no average increase in intraocular pressure (IOP) or increase in noteworthy safety-relevant individual IOP values (or changes thereof). There was no effect on visual acuity or accommodation. 1-week treatment with P4 appeared to be safe 1) in OAG patients treated with topical β-blockers and 2) in NAG patients treated with topical pilocarpine ± β-blockers, irrespective of whether the eyes had previously been treated with glaucoma surgery or laser therapy. .

Screening of intraocular pressure before routine pupil dilation for retinal photography: Clinical case report

Introduction Pharmacologic dilation of the pupil results in twice the sensitivity of detection of diabetic retinopathy compared with undilated retinal examination. The potential risk of acute angle-closure glaucoma after pupil dilation has been hypothesized to be higher in Asian patients with diabetes mellitus. Clinical case A 61-year-old man with diabetes mellitus and hypertension was incidentally found to have elevated intraocular pressure (IOP) before routine retinal photography. He was asymptomatic and the visual acuity was 0.67 for both eyes. An ophthalmologist later found he had anatomical narrow-angle borderline glaucoma. Topical administration of pilocarpine and oral administration of acetazolamide were initiated, and laser iridotomy was later performed. IOP screening Among 1736 diabetic and/or hypertensive patients who underwent IOP screening, 31 patients (1.8%) had IOP of any eye persistently higher than 21 mm Hg on at least two occasions. The mean (standard deviation) IOP of the right eye was 24.1 (2.1) mm Hg, while that of the left eye was 24.6 (2.5) mm Hg. Four patients (12.9%) were found to have glaucoma, and treatment was initiated by an ophthalmologist. Therefore further study should be conducted to evaluate the cost-effectiveness of IOP screening among this group of patients.

Recovery time as a potential new progression parameter for patients with advanced glaucomatous optic atrophy

Functional tests in glaucoma diagnosis can monitor apotential perimetric progression. However white-on-white perimetry is limited in advanced glaucoma, whereas contrasts were detected reproducibly. Especially when stressing (i. e. adapting) the visual system, subsequent measurements yielded different results-the visual system needs a"recovery time". In the present study the recovery time was investigated in patients with advanced glaucoma. Additionally correlation analysis was done with standard perimetric parameters. Temporal contrast sensitivity (TCS) and recovery time (RT) were measured using the Erlanger Flicker Test in 61probands (15normals, 25 primary open-angle glaucomas, 17 secondary open-angle glaucomas, 4 narrow-angle glaucoma). Additionally, ophthalmological examinations and perimetry (Octopus G1) was done. (1) TCS was significantly reduced in patients with advanced glaucoma (p< 0.001). (2) Test stimuli with 3 and 5 % contrast showed alarge variability in contrast to higher contrasts (12 %, 25 %, 35 %). (3) RT12%, RT25% and RT35% were significantly prolonged in advanced glaucoma (p< 0.001). (4) RT25% correlated significantly with mean defect (p= 0.015). Recovery time seems to be apotential parameter in advanced glaucoma follow-up, as it is reproducible, independently of cataract and fixation.

PHARMACOTHERAPY OF PRIMARY CHRONIC GLAUCOMA IN DIABETIC PATIENTS IN RELATION TO MACULAR AREA STATUS

Цель – для назначения рациональной фармакотерапии у больных сахарным диабетом и сопутствующей глаукомой или офтальмогипертензией изучить взаимосвязь остроты зрения с топографическими, морфометрическими показателями макулярной области и наличием других сопутствующих заболеваний.

A Study of profile of glaucoma in eastern UP

Objective: To study the profile of glaucoma patients in Eastern UP. Method: Prospective cross sectional study includes 193 cases of age group (more than 30 years). Both male and female were included. Results: The total number of 193 cases was studied. Out of these 106 (54.9%) were male and 87 (45.07%) were female with a male female ratio was 1.21. Primary glaucoma was more common than secondary glaucoma. Among primary glaucoma, primary narrow angle glaucoma (44.4%) was more common followed by primary open angle glaucoma (36.2%). Mean age of POAG patients was (54.2±7.2 years), PNAG was (60.1±11.1 years), NTG was of (64.6±11.8 years), ocular hypertension was of (55±7.2 years) and secondary glaucoma was of (53.2±11.2 years). PNAG was more common in females and rest of glaucoma was common in male. Glaucoma, Profile, Visual impairment, Eastern U.P. Conclusion: Glaucoma causes progressive atrophy of the optic disc resulting in typical defects in the visual field. It can lead to total loss of vision if left untreated. The diagnosis glaucoma has to be made only after comprehensive eye examination and not only on one parameter. Regular follow up is must to access progression which is essential for glaucoma. Glaucoma awareness has to be created among peoples, for them to get examined at early stage to rule out presence of glaucoma. If glaucoma is found, appropriate management is provided to prevent visual function impairment or loss. Keywords: Glaucoma, Profile, Visual impairment, Eastern UP

Secondary glaucoma following carotid cavernous fistula

Carotid-cavernous fistulas are a major cause of secondary glaucoma due to increased episcleral venous pressure. We present the case of a 72-year-old female patient, treated at the Hospital de Clinicas at the Universidade Federal do Triângulo Mineiro (HC-UFTM), with pain, proptosis, episcleral engorgement, chemosis and pulsation in the right eye, with increased intraocular pressure (IOP) on anti-glaucomatous medication.Arteriography showed dural fistula to the right cavernous sinus, with reflux to orbital veins.Treatment with liquid embolization agent was performed, following full recovery of proptosis and congestion of the episcleral vessels. However, the patient maintained increased IOP because of narrow-angle glaucoma development due to the presence of goniosynechiae in 270o, which was controlled satisfactorily with medication.

Role of Diazepam in Dentistry-A Short Review

Diazepam is often considered the prototypical benzodiazepine and the “grandfather” of the drug class; It is a reliable agent for treating stress and anxiety in adults. Dental patients with generalized anxiety, belonephobia (fear of needles and sharp instruments), prior dental trauma, or generalized fear of the dentist can take diazepam in order to reduce their anxieties. A variety of single and incremental dose protocols are used to medicate the patient as early as the day before treatment. It also can be taken 1 hour before the procedure. Medication additionally helps reduce memory or the sights and smells of the dental office to avoid recall of any trauma. This medication belongs to a class called benzodiazepines which act on the brain and nerves to produce a calming effect. It works by enhancing the effects of a certain natural chemical in the body (GABA). Diazepam also can be given through a vein in the arm for conscious sedation. When given by mouth, diazepam is very safe. But it does often cause side effects, including, forgetfulness, impaired thinking. Certain groups of people should not take diazepam, they are people with narrow-angle glaucoma, people with sleep apnea, pregnant women. It should be administered only by people with advanced training in anesthesiology.

The Role of Aclidinium Bromide in the Treatment of Chronic Obstructive Pulmonary Disease

Introduction: Inhaled bronchodilators remain a cornerstone of treatment for chronic obstructive pulmonary disease (COPD); current guidelines recommend initiating inhaled bronchodilators as either monotherapy or combination therapy depending on disease severity and exacerbation risk to improve air flow and reduce breathlessness. Aclidinium bromide is a twice-daily, long-acting muscarinic antagonist recently approved in the United States and Europe and carries significant promise as an alternative long-acting inhaled antimuscarinic agent for the treatment of moderate-to-severe COPD. Objective: This review describes the pharmacology, pharmacokinetics, clinical efficacy, and adverse effects of aclidinium bromide. Discussion: Clinical trials have demonstrated improvement in forced expiratory volume in 1 second, nighttime symptom control, disease-related quality of life, and delay in time to first COPD exacerbation with aclidinium use compared with placebo. Commonly reported adverse effects include headache, nasopharyngitis, and cough. One trial reported narrow-angle glaucoma; however, no other serious adverse events have been reported to date. Conclusion: Overall, aclidinium bromide has been found to be safe and effective for the treatment of moderate-to-severe COPD. Further clinical trials comparing aclidinium bromide to standard therapies are needed to fully elucidate its role in the treatment of COPD.

Dynamics of outflow easiness coefficient after angular-suprachoroidal drainage in patients with primary glaucoma

Dynamics of outflow easiness coefficient after angular-suprachoroidal drainage in patients with primary glaucoma