Timolol Eye Drops Research Articles

Photocrosslinkable Sericin Hydrogel Injected into the Anterior Chamber of Mice with Chronic Ocular Hypertension Efficacy, Medication Sensitivity, and Material Safety.

(1) Background: A rise in intraocular pressure (IOP) and decreased retinal ganglion cells are frequent indicators of effective modeling of chronic ocular hypertension in mice. In this study, the sensitivity of the mouse model to pharmaceutical therapy to reduce intraocular tension was assessed, the model's safety was confirmed using a cytotoxicity test, and the success rate of the mouse model of ocular hypertension was assessed by assessing alterations in IOP and neurons in the ganglion cell layer. (2) Methods: A mouse model of chronic ocular hypertension was produced in this study by employing photocrosslinkable sericin hydrogel injection and LED lamp irradiation. The eyes of 25 C57BL/6 male mice were subjected to 405 nm UV light from the front for 2 min after being injected with 5 μL of sericin hydrogel in the anterior chamber of the left eye. IOP in the mice was measured daily, and IOP rises greater than 5 mmHg were considered intraocular hypertension. When the IOP was lowered, the intervention was repeated once, but the interval between treatments was at least 2 weeks. The right eyes were not treated with anything as a normal control group. Mice eyeballs were stained with HE, Ni-type, and immunofluorescence to assess the model's efficacy. Two common drugs (tafluprost eye drops and timolol eye drops) were provided for one week after four weeks of stable IOP, and IOP changes were assessed to determine the drug sensitivity of the mouse model of chronic ocular hypertension. Furthermore, CellTiter 96® AQueous One Solution Cell Proliferation Assay (MTS) was utilized to investigate the safety of the ocular hypertension model by evaluating the deleterious effects of photocrosslinkable sericin hydrogel on cells. (3) Results: Before injection, the basal IOP was (9.42 ± 1.28) mmHg (1 kPa = 7.5 mmHg) in the experimental group and (9.08 ± 1.21) in the control group. After injection, cataract occurred in one eye, corneal edema in one eye, endophthalmitis in one eye, iris incarceration in one eye, and eyeball atrophy in one eye. Five mice with complications were excluded from the experiment, and twenty mice were left. Four weeks after injection, the IOP of the experimental group was maintained at (19.7 ± 4.52) mmHg, and that of the control group was maintained at (9.92 ± 1.55) mmHg, and the difference between the two groups was statistically significant (p < 0.05). Before the intervention, the IOP in the experimental group was (21.7 ± 3.31) mmHg in the high IOP control group, (20.33 ± 2.00) mmHg in the tafluprost eye drops group, and (20.67 ± 3.12) mmHg in the timolol maleate eye drops group. The IOP after the intervention was (23.2 ± 1.03) mmHg, (12.7 ± 2.11) mmHg, and (10.4 ± 1.43) mmHg, respectively. Before and after the intervention, there were no significant differences in the high-IOP control group (p > 0.05), there were statistically significant differences in the timolol eye drops group (p < 0.05), and there were statistically significant differences in the tafluprost eye drops group (p < 0.05). One week after drug withdrawal, there was no significant difference in IOP among the three groups (p > 0.05). In the high-IOP group, the protein (sericin hydrogel) showed a short strips or fragmented structure in the anterior chamber, accompanied by a large number of macrophages and a small number of plasma cells. The shape of the chamber angle was normal in the blank control group. The number of retinal ganglion cells decreased significantly 8 weeks after injection of sericin hydrogel into the anterior chamber, and the difference was statistically significant compared with the blank control group (p < 0.05). After the cells were treated with photocrosslinkable sericin hydrogel, there was no significant difference in the data of the CellTiter 96® assay kit of MTS compared with the blank control group (p > 0.05). (4) Conclusions: A mouse model of chronic intraocular hypertension can be established successfully by injecting sericin in the anterior chamber and irradiating with ultraviolet light. The model can simulate the structural and functional changes of glaucoma and can effectively reduce IOP after the action of most antihypertensive drugs, and it is highly sensitive to drugs. Sericin has no obvious toxic effect on cells and has high safety.

Effect of nadolol in treatment of induced ocular hypertension in rabbits

In glaucoma, as optic neuropathy gradually proceeds unnoticed by the patient, early detection and treatment is of paramount importance in arresting or controlling the progress of damage. To explore effects of topical nadolol on intraocular pressure (IOP) ocular hypertensive eyes of rabbits. A group of 36 males of the rabbits were included in this study. Induction of ocular hypertension was achieved by injection of hydroxy propyl methylcellulose in the anterior chamber of rabbits right eye. The present study was designed to evaluate the possible beneficial therapeutic effect. The included rabbits were divided into distilled water group, timolol (0.25% and 0.5%) groups, and nadolol (0.25% and 0.5%). Each of drug eye drops (including distilled water) were instilled into right eyes 3 times/day for 10 days therapeutically. The rabbits had been examined for the IOP, pupil diameter, light reflex, corneal reflex, and conjunctival redness prior to instillation of drugs and along the trial period. Results: Ocular hypotensive effects of nadolol (0.25%) and (0.5%) eye drops were more efficient than that of distilled water (P&lt;0.01). Furthermore, nadolol eye drop was more efficient than timolol eye drop (0.01&gt;P&gt;0.05) in its ocular hypotensive effect in both concentrations along the trial period. In both parts of the present study and regarding each of mean pupil diameter, light reflex, corneal reflex and conjunctival redness, nadolol (0.25% or 0.5%) eye drops had no significant adverse effect (P &gt; 0.05). Conclusions: Nadolol eye drops instilled 3 times / day had an obvious beneficial, safe, and tolerable therapeutic ocular hypotensive effects on hydroxy propyl methyl cellulose - induced ocular hypertension in rabbits.

Travoprost Intracameral Implant for Open-Angle Glaucoma or Ocular Hypertension: 12-Month Results of a Randomized, Double-Masked Trial.

This prospective, multicenter, randomized, double-masked pivotal phase3 trial evaluated the efficacy and safety of the travoprost intracameral SE-implant (slow-eluting implant, the intended commercial product) and FE-implant (fast-eluting implant, included primarily for masking purposes) compared to twice-daily (BID) timolol ophthalmic solution, 0.5% in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). The trial enrolled adult patients with OAG or OHT with an unmedicated mean diurnal intraocular pressure (IOP) of ≥ 21 and unmedicated IOP ≤ 36mmHg at each diurnal timepoint (8A.M., 10A.M., and 4P.M.) at baseline. The eligible eye of each patient was administered an SE-implant, an FE-implant or had a sham administration procedure. Patients who received an implant were provided placebo eye drops to be administered BID and patients who had the sham procedure were provided timolol eye drops to be administered BID. The primary efficacy endpoint, for which the study was powered, was mean change from baseline IOP at 8A.M. and 10A.M. at day10, week6, and month3. Non-inferiority was achieved if the upper 95% confidence interval (CI) on the difference in IOP change from baseline (implant minus timolol) was < 1.5mmHg at all six timepoints and < 1mmHg at three or more timepoints. The key secondary endpoint was mean change from baseline IOP at 8A.M. and 10A.M. at month12. Non-inferiority at month12 was achieved if the upper 95%CI was < 1.5mmHg at both timepoints. Safety outcomes included treatment-emergent adverse events (TEAEs) and ophthalmic assessments. A total of 590 patients were enrolled at 45 sites and randomized to one of three treatment groups: 197 SE-implant (the intended commercial product), 200 FE-implant, and 193 timolol. The SE-implant was non-inferior to timolol eye drops in IOP lowering over the first 3months, and was also non-inferior to timolol at months6, 9, and 12. The FE-implant was non-inferior to timolol over the first 3months, and also at months6 and 9. Of those patients who were on glaucoma medication at screening, a significantly greater proportion of patients in the SE- and FE-implant groups (83.5% and 78.7%, respectively) compared to the timolol group (23.9%) were on fewer topical glaucoma medications at month12 compared to screening (P < 0.0001, chi-square test). TEAEs, mostly mild, were reported in the study eyes of 39.5% of patients in the SE-implant group, 34.0% of patients in the FE-implant group and 20.1% of patients in the timolol group. The SE-travoprost intracameral implant demonstrated non-inferiority to timolol over 12months whereas the FE-implant demonstrated non-inferiority over 9months. Both implant models were safe and effective in IOP lowering in patients with OAG or OHT. ClinicalTrials.gov identifier, NCT03519386.

ANGLE RECESSION, THE SEQUELA OF EIGHT-BALL HYPHEMA AFTER SPRAYED BY FIRE HYDRANT: A CASE REPORT

Introduction : Hyphema results from damage to the blood vessels of the iris or anterior ciliary body after blunt trauma, and in 56–100% of cases can occur angle recession.&#x0D; Case Illustration : A 40-year-old man complaints of pain and blurred left eye after being sprayed by a high-pressure fire hydrant five hours before coming to the emergency room. Visual acuity was 20/20 and hand movement in right and left eye, IOP is 13 mmHg and 18 mmHg in both eyes. Subconjunctival bleeding, conjunctival and pericorneal injections were found with punctate fluorescein test in the left eye. The cornea was edema and the anterior chamber was full of hyphema. Five days after being hospitalized and treated with topical atropine, antibiotics, and steroid in combination with oral tranexamic acid, the visual acuity was 5/6.5 and the hyphema was resolved. The IOP elevated after 1-6 weeks of follow-up in the outpatient clinic then timolol eyedrops were given. Gonioscopy showed widening of CBB, torn iris processus 2 clock hours in the inferior quadrant. The antiglaucoma medication was stopped due to the controlled IOP in the end episode of the treatment.&#x0D; Discussion : Angle recession involves a tear between the longitudinal and circular muscle fibres of the ciliary body. Medication is needed to control the IOP, while surgical management only indicated in cases where medical treatment fails to control the IOP and risk of progressive visual loss.&#x0D; Conclusion : Angle recession can occur after blunt eye trauma with hyphema and IOP control is needed to prevent the development of secondary glaucoma.

Sudden Ocular Complication after Snake Bite

Introduction : A snakebite constitutes a common acute medical emergency and has several systemic and even ocular consequences. Snake venom neurotoxins act mainly on the peripheral nervous system at the neuromuscular junction and can affect the cranial nerves. Neurological symptoms that relate to cephalic muscle paralysis include exotropia, ptosis, diplopia and ophthalmoplegia.&#x0D; Case Illustration : A 17 years old man came to emergency department with painful swelling on his left hand and sudden blurred vision right after his left hand were bitten by venomous snake in the rice field. Diplopia and ptosis were developed several hours after admission. On eye examination, visual acuity was 0,05 on right eye and 0,8 on left eye, abnormal pupillary reflects on both eyes were present, pupil dilatation, limited eye movement and ptosis were present, Intraocular pressure were 23,7 mmHg on right eye and 24,5 mmHg on left eye. Antivenom was administered immediately. He received cycloplegic, timolol eyedrop, and prednisolone eyedrop for ocular treatment&#x0D; Discussion : Ocular complications are rare and uncommon but they may lead to sight-threatening conditions. Snake venom neurotoxins act mainly on the peripheral nervous system at the neuromuscular junction and can affect the cranial nerves. Mild neurological symptoms that relate to cephalic muscle paralysis include exotropia, ptosis, diplopia and ophthalmoplegia.&#x0D; Conclusion : This study presented a rare case of systemic ocular complication as a result of a snake bite. Ophthalmoplegia induced ocular discomfort for an extended period is a rare symptom of snake-bites. Combined treatment of steroid with antivenom may improve the recovery from sudden ocular manifestation in snake bite.

An Observational Study of Clinical Efficacy of Travoprost and Timolol Eye Drops for Senile Glaucoma

An Observational Study of Clinical Efficacy of Travoprost and Timolol Eye Drops for Senile Glaucoma

Efficacy of Topical Timolol Eye Drops in Treatment of Myopic Regression After Small Incision Lenticule Extraction: A Case Report

Purpose: To describe a patient with high myopia who experienced slight myopic regression twice during follow-up after small incision lenticule extraction (SMILE), which can be eased by topical treatment of timolol. Methods: Case report. Results: Six months after a SMILE procedure for high myopia in both eyes, the patient's uncorrected distance visual acuity (UDVA) was 0.8 and both eyes lost one line compared to preoperative corrected distance visual acuity (CDVA) by myopic shift, which was accompanied by central corneal epithelial thickening. After 2 months of treatment with topical timolol eye drops, the UDVA improved two more lines with flattened corneal curvature and thinned epithelial thickness. After 5 months without timolol treatment, he lost two lines of UDVA again with thicker epithelial thickness. After another 2 months of treatment with timolol, the epithelial thickness could be seen to have thinned month by month, and the UDVA improved two or more lines. There was no notable myopic shift in both eyes for the next 3 months with medication withdrawal. During the whole follow-up period, the change in corneal and epithelial thickness remarkably fluctuated with the timolol treatment, but the posterior corneal curvature was stable. Conclusions: This case report describes refractive regression that can repeatedly occur in the middle and long term after a SMILE procedure for high myopia, which could be correlated with the thickening of the central corneal epithelium. Treatment with timolol eye drops can help to improve visual acuity by thinning the compensated epithelial thickness to flatten corneal curvature. [ Journal of Refractive Surgery Case Reports. 2023;3(4):e47–e52.]

The intraocular pressure reducing- potential of topically administered aqueous extract of Dennetia Tripetala on Wistar strain albino rats

The second section of manuscript should contain Abstract and Keywords. Abstract should be informative, self-explanatory and easy to understand. Plant parts have continued to attract attention in the global search for the treatment of many diseases affecting humans. Dennetia tripetala (mmimi) is a well-known spicy indigenous forest fruit from the family annonacea and has been found to contain lots of minerals, vitamins, alkaloids and trace elements which are of medicinal importance. This study investigated the effect of topical ripe and unripe Dennetia tripetala seed extracts on the intraocular pressure of albino Wistar rats. Fifteen healthy male albino Wistar rats were used for the study. The rats were randomly divided into 3 groups (A, B, C), each group consisting of 5 rats. Group A rats were treated with one drop of ripe seed extract in their right eye and one drop of Timolol eye drop in their left eye. Group B rats received one drop of unripe seed extract in their right eye and one drop of Timolol eye drop in their left eye. Group C rats served as control (received one drop of water in OD). The I0P of each rat was measured pre and post instillation of one drop volume of the solutions at 30 mins interval for 120 minutes. The findings showed peak reduction of IOP after 60 mins (6.02 mmHg, representing 31.2 % reduction) of instillation one drop volume of ripe D. tripetala seed extract and reverted towards baseline (19.16 mmhg). The peak effect of ripe D. tripetala was found to be statistically significant (P =4.558). Unlike ripe D. tripetala seed extract, the unripe extract induced consistent IOP reduction till 120 minutes (5 % after 30 minutes, 16.5 % after 60minutes and 17.9 % after 120 minutes) from the baseline (18.84 mmHg). The reduction in IOP after 60 minutes (P = .4145) and 120 minutes was statistically significant (P= 2.5448). When compared with Timolol, Timolol produced steady and highest IOP reduction (15 %, 23.5 %, and 33.3 % from the baseline) 30 minutes, 60 minutes and 120 minutes post instillation respectively. Topical administration of aqueous extract of ripe D. tripetala seed significantly reduced intraocular pressure in albino Wistar rats, suggesting anti-glaucoma effect of the extract.

Objective assessment of the variation in number of doses of generic timolol eye drops along with their cost effectiveness.

First, this study aims to ascertain if truly the generic timolol eye drops circulating in Abuja and it environ are interchangeable. Secondly, we explore their cost effectiveness in naira based on the dispensing position. Using official guidelines, we assessed seven generic timolol ophthalmic preparations for organoleptic, pH, viscosity, sterility, and assay test. After this, they were tested in the vertical (90 ⁰) and horizontal (30 ⁰) positions for filled volume in a bottle, the total number of drops per bottle, drops per mL; and eventually the total number of bottles needed per year, cost per year and their cost effectiveness per mmHg were extrapolated. All brands were colorless and devoid of particulate contamination. Assay, pH, and viscosity values were within the compendia specification (BP and USP) for eye drops. The sterility assay showed no evidence of bacterial or fungi growth. All brands had actual filled volume less than or equal to the stated label claim. Their drops per 5 mL bottle range from 141-169 and 122-139 when dispensed in vertical and horizontal positions respectively; while for brands with 10 mL label volume, they range from 305-321 and 299-309 drops per bottle for vertical and horizontal dispensing respectively. Brand T1 (which is the most expensive) would need two bottles less in a year if the medication were to be dispensed vertically, amounting to N 3,200.00 ($ 7.04) reduction in treatment cost and a 45 % improvement in cost-effectiveness per intraocular pressure (IOP) reduction per year. In conclusion, the dispensing technique played a significant role in the number of drops per bottle, this would however impact on the treatment cost of glaucoma patient placed on timolol eye drop.

Drug utilization, medication adherence and treatment satisfaction amongst glaucoma patients receiving care at secondary health facilities

Abstract Objectives The objective of this study was to assess treatment satisfaction, medication adherence and drug utilization amongst glaucoma patients receiving care at secondary health facilities. Methods A cross-sectional study was conducted amongst glaucoma patients attending eye clinics of General Hospital Ilorin and Civil Service Hospital Ilorin in Kwara State, Nigeria from October 2020 to January 2021. Three hundred and eleven patients were enrolled in the study. Sampling was based on convenience as dictated by the inclusion and exclusion criteria. Ethical permission and informed consent were obtained before data collection. Validated instruments of Morisky Medication Adherence Scale and Treatment Satisfaction Questionnaire for Medication were used during the data collection process. Descriptive and Chi-square analyses were employed. Key findings Amongst the 311 patients studied 184(59.2%) were females with a mean age of 63.79 ± 14.89 years. Timolol eye drop was the drug of choice for monotherapy in (8.7%) of patients. Combination therapy of beta blockers and carbonic anhydrase inhibitors had the highest number (59.5%) of prescriptions. More than half (55.6%) of the patients were adherents. Participants reported being more satisfied with their anti-glaucoma therapy in the domain of global satisfaction (62.89 ± 21.85) followed by medication effectiveness (62.67 ± 20.78) and convenience (60.16 ± 15.79) while medication side effects had the least score (17.17 ± 11.09). There is a statistically significant relationship between patient satisfaction with treatment and medication adherence at P= 0.001. Conclusions Combination therapy was the most frequently utilized anti-glaucoma agent. Most of the patients adhered to their medications and were satisfied with the treatment received.

Management of canine glaucoma using a combination of dorzolamide and timolol

A study was conducted in twelve glaucomatous dogs to assess the efficacy of the combination of dorzolamide and timolol in the treatment of glaucoma in dogs. The study included twelve dogs with glaucoma of any age, breed, or gender. On the day of presentation, the 14th, 28th and 42nd days, the intraocular pressure (IOP) was monitored with an applanation tonometer. For 42 days, all dogs received topical instillation of a combination of dorzolamide (2%) and timolol (0.5%) eye drops, one drop twice daily. In all the dogs, there was a shift in IOP towards the established normal level within two weeks of therapy. The study revealed that topical use of a combination of dorzolamide and timolol eye drops twice daily was successful in lowering IOP in dogs with glaucoma.

Forced degradation of timolol maleate on high temperature for verification of HPLC method for related substances in Timolol eye drop 0.5%

Forced degradation of timolol maleate on high temperature for verification of HPLC method for related substances in Timolol eye drop 0.5%

Herpes zoster masquerading viral endophthalmitis after ozurdex intravitreal implant

A 64-year-old gentleman presented with decreased vision, raised intraocular pressure, and anterior chamber reaction of 1+ with grade 3 vitreous exudates on day 5 after intravitreal Ozurdex® implant. Microbiological culture showed no bacterial or fungal growth. On suspicion of viral endophthalmitis, the patient was started on topical prednisolone, moxifloxacin, atropine, dorzolamide, and timolol eye drops and oral valacyclovir 1 g twice a day for 10 days. On day 9, a vesicular eruption was noted on the left forehead, confirming the diagnosis of herpes zoster-related shingles infection. Complete resolution of inflammation was noted on day 30. This is the first case report highlighting the occurrence of ocular zoster infection after an intravitreal Ozurdex® implant.

Efficacy of Timolol Maleate (0.5%) in Preventing Rise of Intraocular Pressure (IOP) Post Neodymium: Yttrium Aluminum Garnet (Nd: YAG) Capsulotomy

Objective: To determine the efficacy of 0.5% Timolol eye drops in preventing rise of intraocular pressure following Neodymium: Yttrium-Aluminum-Garnet laser posterior capsulotomy.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Outpatient Department of Ophthalmology, Combined Military Hospital Multan Pakistan, from May to Nov 2019.&#x0D; Methodology: Patients presenting with posterior capsule opacification, undergoing elective Neodymium: Yttrium Aluminum Garnet (Nd: Yag) Capsulotomy were enrolled in the study. Patients were alternatively assigned to two groups; group-1 was administered 0.5% Timolol Maleate eye drops, while group-2 was administered placebo natural team eye drops. Intraocular pressure for all the patients was measured at three-time points a). First measurement was baseline intraocular pressure at presentation/before the treatment. Second measurement was 1-hour post laser capsulotomy and third measurement was 3 hours post laser capsulotomy.&#x0D; Results: At 1-hour follow up, the mean intraocular pressure was significantly raised in the patients belonging to control group as compared to treatment group (21.45 ± 8.33 mm Hg vs 15.33 ± 3.37 mm Hg, p&lt;0.001). At 3-hours follow-up the mean intraocular pressure decreased a bit for control group but still was significantly higher than the treatment group (17.40 ± 3.00 mm Hg vs 15.60 ± 2.30 mm Hg, p&lt;0.001).&#x0D; Conclusion: Prophylactic use of Timolol successfully reduces the post-procedural acute rise in intraocular pressure due to Neodymium: Yttrium Aluminum Garnet laser posterior capsulotomy.

Efficacy and safety of topical timolol 0.5% plus saline 0.9% versus each one alone in acne scar trichloroacetic acid-CROSS therapy: A blinded randomized controlled trial.

Trichloroacetic acid-CROSS (TCA-CROSS) or chemical reconstruction of scars is an approved method in the treatment of ICE-PICK scars. Timolol is a blocker of beta-adrenergic receptors that speeds up the healing of skin wounds. In this study, for the first time, the TCA-CROSS technique was combined with the use of saline injection and topical timolol to increase the effectiveness of treatment, and reduce the number of treatment sessions and complications, and thus improve the aesthetic result. In this parallel-group split-face randomized controlled assessor and analyst-blinded study, 45 patients with atrophic acne scars were randomly divided into 3 equal groups. TCA-CROSS treatment was performed on all facial scars of patients. In group 1, before TCA-CROSS, saline was injected under the scars on one side of the face, in group 2, after TCA-CROSS, 0.5% timolol eye drops were applied on the scars on one side, and in group 3, saline was injected before TCA-CROSS. After that, timolol eye drops were applied on the scars of the same side. In all groups, the choice of control side was random. The number of scars and patient and physician satisfaction were the main variables evaluating the effectiveness of the treatment. TCA-CROSS improved scars in both control and treatment sides of all 3 groups. Although the number of scars decreased on the treatment side of groups 2 and 3, the decrease was not statistically significant. In the saline + TCA group, the number of scars on the treatment side was slightly more than on the control side. In the group of patients who used timolol, the severity and duration of scar hyperpigmentation were significantly lower (group 2 p= 0.016, group 3 p= 0.002). No permanent complication was observed in the patients. Patients' satisfaction in groups 2 and 3 was higher in the treatment side than the control side. The combination of saline injection followed by TCA-CROSS is not recommended. Application of 0.5% timolol after TCA-CROSS caused a slight decrease in scar severity and a significant reduction of post-inflammatory hyperpigmentation (PIH) duration. So, the topical timolol makes a better result of TCA-CROSS for acne scar treatment.

Selective laser trabeculoplasty versus 0·5% timolol eye drops for the treatment of glaucoma in Tanzania: a randomised controlled trial

SummaryBackgroundGlaucoma is a major cause of sight loss worldwide, with the highest regional prevalence and incidence reported in Africa. The most common low-cost treatment used to control glaucoma is long-term timolol eye drops. However, low adherence is a major challenge. We aimed to investigate whether selective laser trabeculoplasty (SLT) was superior to timolol eye drops for controlling intraocular pressure (IOP) in patients with open-angle glaucoma.MethodsWe did a two-arm, parallel-group, single-masked randomised controlled trial at the Eye Department of Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Eligible participants (aged ≥18 years) had open-angle glaucoma and an IOP above 21 mm Hg, and did not have asthma or a history of glaucoma surgery or laser. Participants were randomly assigned (1:1) to receive 0·5% timolol eye drops to administer twice daily or to receive SLT. The primary outcome was the proportion of eyes from both groups with treatment success, defined as an IOP below or equal to target pressure according to glaucoma severity, at 12 months following randomisation. Re-explanation of eye drop application or a repeat SLT was permitted once. The primary analysis was by modified intention-to-treat, excluding participants lost to follow-up, using logistic regression; generalised estimating equations were used to adjust for the correlation between eyes. This trial was registered with the Pan African Clinical Trials Registry, number PACTR201508001235339.Findings840 patients were screened for eligibility, of whom 201 (24%) participants (382 eligible eyes) were enrolled between Aug 31, 2015, and May 12, 2017. 100 (50%) participants (191 eyes) were randomly assigned to the timolol group and 101 (50%; 191 eyes) to the SLT group. After 1 year, 339 (89%) of 382 eyes were analysed. Treatment was successful in 55 (31%) of 176 eyes in the timolol group (16 [29%] of 55 eyes required repeat administration counselling) and in 99 (61%) of 163 eyes in the SLT group (33 [33%] of 99 eyes required repeat SLT; odds ratio 3·37 [95% CI 1·96–5·80]; p<0·0001). Adverse events (mostly unrelated to ocular events) occurred in ten (10%) participants in the timolol group and in eight (8%) participants in the SLT group (p=0·61).InterpretationSLT was superior to timolol eye drops for managing patients with open-angle high-pressure glaucoma for 1 year in Tanzania. SLT has the potential to transform the management of glaucoma in sub-Saharan Africa, even where the prevalence of advanced glaucoma is high.FundingChristian Blind Mission, Seeing is Believing Innovation Fund, and the Wellcome Trust.TranslationsFor the Kiswahili, French and Portuguese translations of the abstract see Supplementary Materials section.

Selective laser trabeculoplasty versus 0·5% timolol eye drops in the management of glaucoma in Tanzania

Africa has the highest prevalence of glaucoma blindness worldwide.1 Factors such as insufficient awareness and knowledge about the disease, poverty of resources, competing individual needs, scarce access to affordable treatment, low ophthalmologist to population ratio, ineffective government policies, and collapse of primary health-care services in many countries2 all contribute to the burden of this condition in sub-Saharan Africa.

Topical timolol 0.5% as the primary treatment of ophthalmic pyogenic granuloma: A prospective, single-arm study

Purpose:To study topical timolol (0.5%) as a first-line treatment in ophthalmic pyogenic granuloma (PG) in terms of safety and efficacy.Methods:This was a prospective, interventional, single-arm study conducted at a tertiary eye care hospital in central India. Only new cases of PG were counseled to get enrolled in the study. A total of 40 patients were analyzed in the study. Topical timolol eye drop (0.5%) was started in each patient twice daily for 4–6 weeks duration. The patients were divided into five categories according to the percentage reduction in the size of PG as follows: i) 80–100% reduction - excellent responders, ii) 60–80% – good, iii) 40–60% – satisfactory, iv) 20–40% – poor, and v) <20% – very poor/nonresponder. After 6 months of starting treatment final evaluation was done.Results:The mean age of the patients was 23.5 ± 13.3 years. Etiology of the disease included chalazion (n = 11, 27.5%), trauma (n = 2, 5%), surgery (n = 7, 17.5%), foreign body (n = 2, 5%), and idiopathic (n = 18, 45%). An excellent response was achieved in 31 (77.5%) patients. Twenty-seven (67.5%) patients had complete resolution of lesions within 6 weeks. Recurrence of the lesion was not noticed in any patients.Conclusion:Timolol 0.5% in topical form is a good treatment option for ophthalmic PG in all age groups. The treatment has no adverse effects when given to suitable individuals for a limited period.

Sinus bradycardia following single-day use of timolol eye drops in a healthy young adult - A rare case report

We report the rare case of timolol-induced sinus bradycardia in an otherwise healthy young individual following just 1 day use of timolol eye drops. A 35-year-old male presented with dispersed hyphema and raised intraocular pressure following blunt trauma in the left eye. He was prescribed timolol eye drops and topical steroids. He presented next day with giddiness, sweating, and heart rate (HR) of 30/min. Electrocardiogram confirmed sinus bradycardia injection atropine 0.5 mg intravenous was given. Timolol was substituted with brimonidine-brinzolamide drops. HR returned to normal of 72/min after 2 days of observation. Our case, therefore, represents an exaggerated response to topical timolol.

A comparative study of timolol plus either brimonidine (0.2%) or dorzolamide (2%) or latanoprost (0.005%) dual therapy in suboptimal responders to timolol (0.5%) monotherapy among patients of open-angle glaucoma, ocular hypertension, and normal-tension glaucoma

Background: Studies comparing the efficacy and tolerability of the three fixed combinations of timolol with its monotherapy are not readily available. In this background, the current prospective observational study was planned. Aim and Objective: To evaluate and compare the intraocular pressure (IOP) reduction, change in visual field, and cup-disc ratio in glaucoma patients receiving timolol monotherapy vis-a-vis timolol based dual therapies among timolol sub-optimal responders. Materials and Methods: After obtaining written informed consent and fulfilling the inclusion-exclusion criteria, fifty consecutive newly diagnosed cases of glaucoma or ocular hypertension with risk factors were recruited in the study. They received timolol eye drop up to 4th week. Participants not responding to timolol monotherapy optimally received either timolol plus brimonidine or timolol plus dorzolamide or timolol plus latanoprost for another 12 weeks. Participants responding optimally (at least 30% reduction of baseline) were continued with timolol monotherapy. Besides IOP changes, effects on visual field, visual acuity, cup disc ratio, safety, tolerability, and rate of persistency to therapy were studied. Results: Fifteen participants (30%) achieved target IOP reduction at 4 weeks of timolol monotherapy. All four treatment groups achieved significant IOP reduction (P < 0.001) from baseline to 16th week. Participants receiving timolol followed by timolol plus latanoprost had shown the highest IOP reduction at 16th week both from baseline and 4th week value (ANOVA test, P = 0.027, P = 0.000 respectively). No change in visual field or visual acuity or cup disc ratio was noticed. Adverse drug reactions observed were mild and mostly self limiting. Conclusion: Timolol and latanoprost combination might be a better choice in sub-optimal responders to timolol whereas it is wise to continue timolol monotherapy in optimally responders.