Treatment Of Open-angle Glaucoma Research Articles

A Cost-Utility Analysis of Trabecular Bypass Devices Versus Usual Care for Patients With Open-Angle Glaucoma.

ObjectiveThe aim of this study was to determine whether insertion of a trabecular bypass device (TBD) is a cost-effective intervention for the treatment of open-angle glaucoma (OAG) with mild to moderate vision loss in the Australian setting.MethodsWe performed a cost-utility analysis of TBD implantation in conjunction with cataract surgery or as a standalone procedure in patients with OAG. The model used a Monte Carlo simulation to follow individual patients through a glaucoma treatment algorithm that included TBD and compared the costs and outcomes with those of patients simulated through an algorithm without TBD (usual care). The model tracked the intraocular pressure (IOP) of individual patients and then, based on this IOP, tracked the progression of the patient’s glaucoma. Utility values were assigned dependent on severity of glaucoma. The analysis took the perspective of the Australian health care system. The main outcome was incremental cost per quality-adjusted life-year (QALY) of TBD versus usual care for the treatment of OAG.ResultsIn the cataract surgery population, TBD surgery was associated with incremental healthcare costs of A$177 and 0.0726 QALYs per patient, resulting in an incremental cost per QALY gained of A$2430. In the standalone population, the overall incremental cost of TBD surgery versus usual care was A$2234. With QALYs gained of 0.1526 per patient, this equated to an incremental cost per QALY gained ratio of A$14,644.ConclusionThe incremental cost per QALY estimates for TBD were below thresholds generally accepted by Australian healthcare payers, suggesting that TBD is a cost-effective intervention for patients with primary OAG in the Australian setting.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-021-00312-4.

Noninferiority Study Comparing Latanoprost 0.005% Without Versus With Benzalkonium Chloride in Open-Angle Glaucoma or Ocular Hypertension.

To evaluate the noninferiority of intraocular pressure (IOP)-lowering latanoprost without benzalkonium chloride (BAK) versus latanoprost with BAK (for treatment of open-angle glaucoma or ocular hypertension). Overall, 578 patients were randomized 1:1 to latanoprost without BAK or latanoprost with BAK once daily in the affected eye(s) for 12 weeks. The primary efficacy endpoint was IOP, measured on days 0, 7, 28, 56, and 84 (8 am, 10 am, and 4 pm). Noninferiority was established if the following criteria were met: 95% confidence interval (CI) of the mean difference between treatments included 0 mm Hg for all time points (N1), 95% CI upper limit less than 1.5 mm Hg (N2), and less than 1 mm Hg for≥7 of 12 time points (N3). Primary efficacy analysis was performed on the intent-to-treat population. Safety measurements included ocular and systemic adverse event (AE). The 95% CI included 0 mm Hg for 7/12 time points (N1), 95% CI upper limit was less than 1.5 mm Hg for 12/12 time points (N2), and less than 1.0 mm Hg for 4/7 time points (N3). AEs were mild and similarly distributed between groups. Latanoprost without BAK did not meet two of three criteria for noninferiority and showed a similar safety profile relative to latanoprost with BAK.

“DURYSTA” the first biodegradable sustained release implant for the treatment of open-angle glaucoma

A study for “DURYSTA” in the treatment of open angle glaucoma has been done in this work. A angle between the cornea and iris is open whereas the trabecular meshwork is partially blocked, that obstructs the outflow of aqeous humor and lead to vision loss and damage the optic nurve that is known as open angle glucoma. This model presented the study for outflow of watery clear liquid called aqueous humor from the eye through the trabacular meshwork into the Schlemm's Canal in the human eye. This circular lymphatic-like vessel which is called Canal of Schlemm is modeled as a permeable flexible canal with a trabecular meshwork that keeps it open. Aqueous humor seeps through trabacular meshwork and reaches to Schlemm's canal. The inner wall of the canal is porous and it is considered that between two collecting channels the segment of canal is assumed as a circular cross-section tube. In this model, the flow and pressure characteristics of the aqueous fluid are drawn, and the effect of the main limitations and parameters on these profiles is extracted and explained. The effects of “DURYSTA” on these parameter have also been extracted and shown.

Comparative study between timolol maleate and timolol - brimonidine combination in treatment of open-angle glaucoma of moderate intraocular pressure in a tertiary care hospital

To study the efficacy of Timolol Maleate Vs Timolol-Brimonidine combination in lowering the intraocular pressure (IOP) in primary open angle glaucoma (POAG) at a tertiary care hospital. To study any adverse effects of both drug therapies in treatment of POAG. Computerized simple randomization was followed in allocating the patients for the two groups. In each group, n=20, is the total number of patients, and N=30, is the total number of eyes tested, since both eyes were involved in some patients. The concentration of the monotherapy was 0.5% w/v Timolol Maleate and concentration of the combination therapy was 0.2% w/v Brimonidine Tartrate and 0.5% w/v Timolol Maleate. Both drugs were administered twice daily and IOP was recorded every 3 days, for a period of 4 weeks. Monotherapy of Timolol is seen to lower the IOP at 25% in 3 days, whereas the Timolol-Brimonidine combination therapy lowers the IOP at twice the rate that is 50% in 3 days. After reaching a IOP of 12mmHg, which is the normal IOP, both the drugs are used for maintenance therapy. Adverse effects were reported with both groups. Timolol monotherapy is also priced lower, when compared to Timolol-Brimonidine combination therapy. Timolol monotherapy provides the same result as the Timolol-Brimonidine combination therapy and is also comparatively cheaper. Hence, Timolol monotherapy is better suited for the treatment of POAG.

Этапы развития хирургического лечения открытоугольной глаукомы методом синусотомии

This article aims to discuss surgical treatment modalities for glaucoma, focusing on drainage procedures. Today, there are many surgical techniques for the treatment of open-angle glaucoma. However, none of the methods is considered the gold standard efficiency, possible complications, and versatility. The article discusses the stages of improving the technique of sinusotomy, as well as our experience in using this surgical procedure.

A Retrospective Analysis of Safety and Efficacy of XEN 45 Microstent Combined Cataract Surgery in Open-Angle Glaucoma over 24 Months

Objectives:To evaluate the effect on intraocular pressure (IOP) reduction and safety of ab interno gelatin microstent (XEN 45 Gel Stent; Aquesys, Inc, Aliso Viejo, CA, USA) microincisional glaucoma/cataract surgery in open-angle glaucoma (OAG).Materials and Methods:In this retrospective study, 30 eyes of 25 patients with OAG which underwent XEN 45 implantation combined with simultaneous phacoemulsification were clinically evaluated. Clinical outcomes analyzed included IOP, percent of IOP reduction, medication use, complications, best corrected visual acuity, and surgical outcomes at 24-month follow-up.Results:After the XEN 45 combined cataract surgery procedure, IOP dropped from 20.37±4.80 mmHg with a mean of 3.07±1.04 medication classes preoperatively to 14.83±1.91 mmHg with a mean of 0.94±1.11 medication classes at 24 months (p=0.001 for both). At 24 months, 55.6% of patients had IOP ≤18 mmHg without medication, 94.4% of patients had IOP ≤18 mmHg with or without medication, and 61.1% of patients reached ≥20% IOP reduction from baseline.Conclusion:XEN 45 is an effective minimally invasive surgical treatment for OAG with significant reduction in IOP and glaucoma medications and minimal complications in long-term follow-up.

Retrospective Analysis of Outcomes with ab interno Gel Implant in the Treatment of Open Angle Glaucoma

Purpose: To evaluate the intraocular pressure (IOP) lowering and safety profiles of the Xen45 Gel Stent implantation with preoperative Mitomycin C injection during a 6 months follow-up in patients with primary open-angle glaucoma (POAG). 
 Materials and Methods: Records of fourteen eyes of 13 POAG patients who underwent surgery with XEN45 Gel Stent combined with phacoemulsification were evaluated retrospectively. IOP changes, all complications and additional procedures during follow-up period were evaluated. Primary outcome measure was IOP, and the IOP target for complete success was defined as a postoperative IOP drop of more than 20% from preoperative baseline and IOP≥6 and ≤21 at 6 months without any glaucoma medications and qualified success was defined as a postoperative IOP reduction of more than 20% and IOP≥6 and ≤21 at 6 months with or without medications. 
 Results: Mean preoperative medicated IOP was 28.4 ± 2.7 mmHg with a mean of 2.6 ± 0.6 topical anti-glaucoma molecules. After 6 month follow-up period, mean IOP decreased to 17.8 ± 1.5 mmHg (mean IOP reduction of 37%) on 0.4 ± 1.1 antiglaucoma molecules. The complete success rate after 6 months was achieved in 42.8 % and qualified success in 85.7. Totally only 2 (14.2 %) patients required additional procedure (1 needling and 1 trabeculectomy). 
 Conclusions: The study showed that the XEN45 Gel Stent implantation combined with phaco-cataract surgery is an effective surgical method in POAG in case of uncontrolled IOP with a favorable safety profile and low complication rate.

Ab interno supraciliary microstent surgery for open-angle glaucoma.

Glaucoma is the leading cause of global irreversible blindness, oftenassociated with raised intraocular pressure (IOP). Where medical or laser treatment has failed or is not tolerated, surgery is often required. Minimally-invasive surgical approaches have been developed in recent years to reduce IOPwith lower surgical risks. Supraciliary microstent surgery for the treatment of open-angle glaucoma (OAG) is one such approach. To evaluatethe efficacy and safety of supraciliary microstent surgery for the treatment of OAG, and to compare with standard medical, laser or surgical treatments. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2020, Issue 8); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 27 August 2020. We searched for randomised controlled trials (RCTs) of supraciliary microstent surgery, alone or with cataract surgery, compared to other surgical treatments (cataract surgery alone, other minimally invasive glaucoma device techniques, trabeculectomy), laser treatment or medical treatment. Two review authors independently screened titles and abstracts from the database search to identify studies that met the selection criteria. Data extraction, analysis, and evaluation of risk of bias from selected studies was performed independently and according to standard Cochrane methodology. One study met the inclusion criteria of this review, evaluating the efficacy and safety of the Cypasssupraciliary microstent surgery for the treatment of OAG, comparing phacoemulsification + supraciliary microstent surgery with phacoemulsification alone over 24 months. This study comprised 505 eyes of 505 participants with both OAG and cataract, 374 randomised to the phacoemulsification + microstent group. In this study, the perceived risk of bias from random sequence generation, allocation concealment and selective reporting was low. However, we considered the study to be at high risk of performance bias as surgeons/investigators were unmasked. Attrition bias was unclear, with 448/505 participants contributing to per protocol analysis. Insertion of a Cypass supraciliary microstent combined with phacoemulsification probably increases the proportion of participants who are medication-free (not using eye-drops) at 24 months compared with phacoemulsification alone (85% versus 59%, riskratio (RR) 1.27, 95% confidence interval (CI) 1.09 to 1.49, moderate-certainty evidence). There is high-certaintyevidence that agreater improvement in mean IOP occurs in the phacoemulsification + microstent group - mean (SD) change in IOP from baseline of -5.4 (3.9) mmHg in the phacoemulsification group, compared to -7.4 (4.4) mmHg in the phacoemulsification + microstent group at 24 months (mean difference-2.0 mmHg, 95% CI -2.85to -1.15). There is moderate-certainty evidence that insertion of a microstent is probably associated witha greater reduction in use of IOP-lowering drops (meanreduction of 0.7 medications in the phacoemulsification group, compared to a mean reduction of 1.2 medications in the phacoemulsification + microstent group). Insertion of a microstent during phacoemulsification may reduce the requirement for further glaucoma intervention to control IOP at a later stage compared to phacoemulsification alone (RR 0.26, 95% CI 0.07 to 1.04, low-certainty evidence). There is no evidence relating to the rate of visual field progression, or proportion of participants whose visual field loss progressed in this study. There is moderate-certainty evidence showing little or no difference in the proportion of participants experiencing postoperative complications over 24 months between participants in the microstent group compared to those who received phacoemulsification alone (RR 1.1, 95% CI 0.8 to 1.4). Five year post-approval data regarding the safety of the Cypass supraciliary microstent showed increased endothelial cell loss, associated with the position of the microstent in the anterior chamber. There were no reportedhealth-related quality of life (HRQoL) outcomes in the included study. Data from this single RCTshow superiority of supraciliary microstent surgery when combined with phacoemulsification compared to phacoemulsification alone in achieving medication-free control of OAG. However, there are long-term safety concerns with the device used in this trial, relating to the observed significant loss of corneal endothelial cells atfive years following device implantation.At the time of this review, this device has been withdrawn from the market. This review has found that few high-quality studies existcomparing supraciliary microstent surgery to standard medical, laser or surgical glaucoma treatments. This should be addressed by further appropriately designed RCTs with sufficient long-term follow-up to ensure robust safety data areobtained. Consideration of health-related quality of life outcomes should also feature in trial design.

Microinvasive glaucoma surgery: a review and classification of implant-dependent procedures and techniques.

The aim of this article is to discuss how physiology and anatomical background affect the effectiveness of implant‐dependent microinvasive glaucoma surgery (MIGS). First, we provide a micro view of aqueous outflow and tissue behaviour. Second, we review studies exploring the mechanisms of the pressure‐lowering effect of MIGS, as well as tissue behaviour during aqueous flow and tissue motion. We also describe and classify microinvasive surgical procedures and the most important types of implants, as well as their mechanisms of action, implantation techniques and efficacy. Further, we summarize the indications and surgical results presented in recent studies, providing an evidence‐based update on novel and emerging MIGS techniques for the treatment of open‐angle glaucoma. These data can help surgeons to personalize the management of glaucoma and to choose the best MIGS option for individual glaucoma patients.

Standalone XEN45 Gel Stent implantation versus combined XEN45-phacoemulsification in the treatment of open angle glaucoma-a systematic review and meta-analysis.

The XEN45 Gel Stent is currently the only FDA-approved sub-conjunctival minimally invasive glaucoma surgery (MIGS) procedure. It has been used worldwide either as a standalone implantation procedure or in combination with phacoemulsification surgery. Concomitant phacoemulsification is understood to influence outcomes of traditional subconjunctival filtering surgery. However, the comparative efficacy between standalone XEN45 Gel Sent implantation ("Standalone XEN45") and combined XEN-phacoemulsification surgery ("XEN45-Phaco") remains unclear. This study aims to appraise current literature to compare the efficacy of Standalone XEN45 and XEN45-Phaco in open-angle glaucoma. A comprehensive search of PubMed, CINAHL, CENTRAL databases was performed with the terms "Xen surgery" followed by selective vetting. Pilot, cohort, observational studies and randomised controlled trials that included at least 10 patients undergoing either Standalone XEN45 or XEN45-Phaco surgeries for the treatment of open-angle glaucoma were deemed eligible for inclusion after independent assessment by 2 authors. The search workflow was reported according to the PRISMA guidelines. Data was pooled using random-effects model. A meta-analysis of continuous outcome and proportions was performed using the meta routine in R v3.2.1. Ten studies were included. There was a statistically significant difference in IOP reduction favouring Standalone XEN45 at post-operative day 1, week 1, months 1, 3 and 6. There was a statistically significant difference in decrease in IOP-lowering medications favouring Standalone XEN45 at post-operative week 1 and month 1. Standalone XEN45 has superior IOP-lowering outcomes compared to XEN45-Phaco in the early post-operative period, up to 6months after surgery.

Treatment of Open-Angle Glaucoma and Ocular Hypertension with Preservative-Free Tafluprost/Timolol Fixed-Dose Combination Therapy: UK and Ireland Results from the VISIONARY Study

IntroductionReducing intraocular pressure (IOP), the only modifiable risk factor for open-angle glaucoma (OAG), is important for the preservation of vision and slowing of disease progression. Preservative-free tafluprost (0.0015%)/timolol (0.5%) fixed combination (PF Taf-T FC) is an approved combination therapy for OAG treatment. The VISIONARY study aimed to evaluate the effectiveness and tolerability of PF Taf-T FC in real-world clinical settings. Here, we present the results from the United Kingdom (UK) and Ireland.MethodsThis observational, multicentre, European, prospective study recorded data during routine clinic appointments on the use of PF Taf-T FC for the treatment of OAG and ocular hypertension (OHT) in patients whose disease was insufficiently controlled on a prostaglandin analogue (PGA) or beta blocker monotherapy or who did not tolerate these medications. Mean change in IOP, symptom severity, changes in clinical signs, and tolerability were investigated over 6 months.ResultsEighty-two patients were recruited in the UK and Ireland. After 6 months of PF Taf-T FC treatment, mean IOP was significantly reduced from 22.0 to 16.2 mmHg in the UK group and from 18.6 to 14.1 mmHg in the Ireland group. In the UK (65 patients), 49 adverse events (AEs) were reported, of which 3 were serious. No AEs were reported in the Ireland group (17 patients). Overall, 91.9% of UK physicians reported PF Taf-T FC treatment to be the same or better than prior medication for improving clinical signs; 90.0% of UK patients reported PF Taf-T FC treatment to have good or very good tolerability.ConclusionsTreatment with PF Taf-T FC resulted in significant reductions in mean IOP over 6 months. Patients and physicians reported that treatment was well tolerated. These data demonstrate real-world efficacy of PF Taf-T FC for the treatment of OAG and OHT in routine clinical practice in the UK and Ireland.Trial registrationEuropean Union electronic Register of Post-Authorisation Studies (EU PAS) register number, EUPAS22204.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01725-7.

Rhopressa-induced corneal edema: a case report

BackgroundRhopressa (netarsudil) has recently been added to the arsenal of treatment for open-angle glaucoma. It is an effective norepinephrine transporter and Rho-associated protein kinase (ROCK) inhibitor used to decrease intraocular pressure (IOP), with the most common side effect being conjunctival hyperemia.Case presentationWe report a unique case of Rhopressa-induced corneal edema in a 79-year-old African-American woman, which resolved after discontinuation. She had a history of smoking one cigarette per day and did not consume alcohol. She had no history of corneal edema or uveitis.ConclusionsPrevious case reports have documented patients with Rhopressa-induced corneal edema; however, they have all had a preexisting history of corneal edema or uveitis. We believe that this is a unique case of Rhopressa-induced corneal edema in a relatively healthy eye. While Rhopressa is effective in managing glaucoma, there may be effects of treatment that are still unknown. We will discuss clinical findings of our case, along with a review of previous literature on Rhopressa and novel ROCK inhibitors. We hope that we can add to the existing body of literature and invite further investigation of Rhopressa and ROCK inhibitors and their effects on the cornea.

Selective Laser Trabeculoplasty: Outcomes of Multiple Repeat Treatments

To characterize intraocular pressure (IOP) reduction, effect duration, and side effect profile of repeat selective laser trabeculoplasty (SLT) used as primary stand-alone treatment for open-angle glaucoma (OAG). The secondary aim was to investigate covariates associated with treatment response to SLT. Retrospective chart review. A total of 52 patients with treatment-naïve OAG who received 3 installments of 3600 SLT as stand-alone glaucoma therapy. When both eyes met the inclusion criteria, only right eye data were used for analysis. The study was conducted in a single specialist practice. First, second, and third SLT (SLT1, SLT2, SLT3, respectively) treatments were compared for IOP reduction and effect duration. Eyes were classified as "treatment responders" if they had ≥20% IOP reduction 4 to 8 weeks post-SLT compared with baseline. Effect duration was the interval between SLT and the time point at which the surgeon decided inadequate IOP control necessitated repeat SLT. Individuals were excluded if they underwent intraocular surgery during the study period or received treatment with adjunctive ocular hypotensive medications. Reduction in IOP post-SLT and effect duration between treatments. Mean age at SLT1 was 58 years; 50% were male, and 92% were phakic. The SLT1 and SLT3 both resulted in mean 27% IOP reduction at 4 to 8 weeks, whereas SLT2 led to 26% IOP reduction. Response rate (≥20% IOP reduction at 4-8 weeks) was 79% for SLT1, 73% for SLT2, and 81% for SLT3, but the difference was not statistically significant. Response to repeat SLT was not significantly associated with previous SLT outcome. Effect duration was 22.2 months, 33.8 months, and 28.9 months after SLT1, SLT2, and SLT3, respectively. Effect duration was significantly longer after SLT2 (P= 0.0006) and SLT3 (P= 0.0444) compared with SLT1. There was no significant association between SLT response and gender, lens status, or OAG subtype. For primary stand-alone treatment in OAG, initial and repeat SLTs produced comparable percentage IOP reduction, but repeat SLTs had longer effect duration. Intraocular pressure response to SLT was not predictive of the IOP response to subsequent, repeat SLT treatment.

Comparative evaluation of the results of surgical treatment of open-angle glaucoma using an Ex-Press® P-200 filtration device and drainage device “anti-glaucoma implant A3”

Purpose. The article presents the results of a comparative analysis of the effectiveness of surgical treatment of open-angle glaucoma using the Ex-Press P-200 filtering device and the Anti-glaucoma A3 implant.
 Materials and methods. Using simple sequential sampling, 52 patients (59 eyes) were divided into 2 groups. The first group was implanted with Ex-Press P-200, the second with Anti-glaucoma implant A3. The follow-up period for patients ranged from 6 months to three years. At each visit, a standard ophthalmic examination was performed. For tonometry, the ICare TA01i portable non-contact tonometer was used. To assess the stabilization of the glaucoma process, we performed static (threshold) automatic perimetry using the Pericom perimeter and optical coherence tomography (OCT) of the optic nerve heads using a Spectralis HRA-OCT tomograph (Heidelberg Engineering).
 Conclusions. The implantation of devices of both types led to a persistent decrease in intraocular pressure, maintenance of visual functions, and stabilization of the glaucoma process. Intra- and postoperative complications corresponded to the nature of filtering procedures and did not have significant differences in the groups. However, cases of shunt erosion were noted only in the group with implanted Ex-Press devices.

Viscotrabeculotomy versus trabeculectomy in the surgical treatment of open angle glaucoma: a single center, randomised controlled trial.

The aim of the study was to compare the effect of viscotrabeculotomy and the effect of trabeculectomy on the intraocular pressure (IOP) in cases of open angle glaucoma (OAG). Prospective comparative study. The study was conducted on 148 eyes of 148 patients (87 men) presenting with and operated upon for OAG at Mansoura Ophthalmic center of Mansoura University in Mansoura, Egypt from 2012 to 2016. Patients were randomized into viscotrabeculotomy and trabeculectomy groups. Postoperative follow up visits were scheduled at weeks 1 and 2 then months 1, 2, 3, 6, 9, 12, 15, 18, 21 and 24. Complications were noted and managed according to needs. The primary outcome measure was IOP. The study was conducted on 148 eyes (74 right) of 148 patients (87 men). The mean ± SD (range, median) age of the study patients was 50.1 ± 11.5 (20-67, 53) and 51.1 ± 10.0 (27-65, 54.5) years respectively. The mean ± SD (range, median) IOP of the study eyes on maximal tolerated IOP lowering therapy was 23.15 ± 2.31 (19-30, 23.0) and 23.64 ± 1.87 (20-28, 23.0) mmHg respectively and at the end of the 24months of follow up was 14.91 ± 2.4 (12-23, 14) and 16.64 ± 2.8 (14-25, 16) mmHg respectively (p = < 0.0005). Notable complications included a mild hyphema in the viscotrabeculotomy group and an IOP spike in the trabeculectomy group. Viscotrabeculotomy and trabeculectomy showed efficacy and safety in OAG patients. The former resulted in better IOP reduction.

Short-term efficacy of latanoprostene bunod for the treatment of open-angle glaucoma and ocular hypertension: a systematic literature review and a network meta-analysis

Background/aimsTo assess the comparative efficacy of latanoprostene bunod (LBN), a novel prostaglandin analogue (PGA), to other medications for open-angle glaucoma and ocular hypertension on lowering intraocular pressure (IOP).MethodsA systematic literature...

A COMPARATIVE STUDY ON EFFICACY OF FIXED COMBINATION TIMOLOL/BRINZOLAMIDE VERSUS TRAVOPROST MONO-THERAPY IN DRUG-NAÏVE OPEN-ANGLE GLAUCOMA PATIENTS.

Background: Glaucoma is the cause of blindness. Beta blocker and prostaglandins are used as a first line treatment of open angle glaucoma. The exact target with mono therapy for reducing intraocular pressure is achieved within 2 years, so patient prefers fixed dose combination therapy.&#x0D; Objective: For reducing intraocular pressure efficacy, travoprost mono therapy and timolol/brinzolamide fixed dose combination therapy is compared.&#x0D; Material and methods: For 3 months, patients are randomly received 0.5% timolol and 0.2% brinzolamide twice daily and travporost once daily 0.004%.Then compared intraocular pressure, pulse rate, blood pressure, and cup disc ratio over 12 weeks of treatment.&#x0D; Results: 27.99% and 30.49% reduction in intraocular pressure is observed with mono therapy and fixed dose combination respectively. Pulse rate (9beats/min) and systolic pressure reduction by (2.35mmHg) were seen with fixed dose combination but no cup disc ratio observed.&#x0D; Conclusion: It is proved that 0.5% timolol and 0.2% brinzolamide causes more reduction in intraocular pressure than the 0.004% travporost mono therapy.&#x0D; Keywords: Glaucoma, travporost and lantoprost

Netarsudil for the Treatment of Open-Angle Glaucoma and Ocular Hypertension: A Literature Review.

To evaluate netarsudil's role as first-line therapy for the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT). A literature search utilizing MEDLINE and CINAHL was performed using netarsudil and AR-13324 as keywords. Studies published from January 1970 to September 2020 were eligible. For inclusion, articles were required to be published in English and participants enrolled in phase I, II, or III clinical trials. Articles were excluded if netarsudil was coformulated with another medication. Preclinical research, case reports, case series, review articles, citations without an abstract, and newsletters were excluded. The search retrieved 97 unique citations; 90 results were excluded, and 7 studies were included for analysis. In all, 20 years elapsed between the Food and Drug Administration's approvals of distinct medications to treat OAG. Existing first-line therapies target the uveoscleral pathway, which is responsible for a small amount of aqueous humor outflow. Rho kinase inhibitors target the trabecular pathway, which is responsible for 90% of aqueous humor outflow; thus, Rho kinase inhibitors may significantly reduce intraocular pressure and improve clinical outcomes for patients with OAG or OHT. Evidence demonstrates that netarsudil is inferior to prostaglandin analogues and noninferior to topical β-blockers in the treatment of OAG and OHT. Hyperemia is a common adverse drug reaction, which often resolves after medication discontinuation. Additional phase III clinical trials and evidence-based guidelines are necessary to determine netarsudil's position in OAG and OHT management.

Laser Trabeculoplasty for Open-Angle Glaucoma: A Systematic Review and Network Meta-Analysis

We sought to comprehensively evaluate the effectiveness of different types of laser trabeculoplasty (LT) in the treatment of open-angle glaucoma. Systematic review and network meta-analysis. Eligible randomized controlled trials were identified by searching PubMed, EMBASE, Cochrane Library, SCOPUS, China National Knowledge Infrastructure, and the Chinese Biomedical Literature Service System for studies published between January 1, 2000 and April 20, 2020. Eight interventions were evaluated, including argon LT (ALT), medications, 180-degree selective LT (SLT), 270-degree SLT, 360-degree SLT, new LT, transscleral 360-degree SLT with SLT performed without gonioscopy, and low-energy 360-degree SLT. The primary outcome was reduction of medicated and unmedicated intraocular pressure (IOP) at 6months. Secondary outcomes included reduction of IOP at 12months, incidences of complications, and change in number of medications. Head-to-head meta-analysis and network meta-analysis were performed using Stata and R software. In total, 22 studies were included, involving 2859 eyes of 2704 patients. In terms of IOP reduction at 6 and 12months, there were no statistically significant differences in both medicated and unmedicated IOP between any pairs of interventions considered herein, as determined based on both head-to-head and network meta-analyses (all P > .05). In terms of reduction of medications, the individuals treated with 180-degree SLT required fewer medications than those treated with ALT at 12months (0.28 [95% confidence interval, 0.06-0.50]; P= .014). No severe adverse outcomes were reported for any of the interventions. All the available types of LT are equally effective for decreasing IOP compared with medication-based therapy. The 180-degree SLT was slightly more effective than ALT in terms of reducing the number of medications needed. Additional well-performed randomized controlled trials with larger sample sizes are needed.

Impact of referral refinement on management of glaucoma suspects in Australia

BackgroundIn ageing populations, the prevalence of chronic diseases such as glaucoma is projected to increase, placing additional demands on limited health‐care resources. In the UK, the demand for secondary care in hospital eye clinics was inflated by high rates of false positive glaucoma referrals. Collaborative care models incorporating referral refinement, whereby glaucoma suspect referrals are triaged by suitably trained optometrists through further testing, can potentially reduce false positive referrals. This study examined the impact of a referral refinement model on the accuracy of glaucoma referrals in Australia.MethodsOptometrist‐initiated glaucoma suspect referrals to the Glaucoma Management Clinic (Sydney, Australia) were prospectively recruited. Glaucoma suspect referrals arising from two pathways were eligible for inclusion, either directly from a community optometrist (standard care) or following comprehensive assessment at the Centre for Eye Health (referral refinement). Main outcome measures were the positive predictive value and false positive rate of referrals. The impact of referral letter content on management outcomes was also investigated.ResultsOf 464 referrals received between March 2015 and June 2018, 252 were for treatment of naïve glaucoma suspects and eligible for inclusion. Following ophthalmological assessment, 45.6 per cent (n = 115/252) were prescribed treatment for open angle glaucoma or ocular hypertension. Positive predictive value of community optometry referrals was 33.8 per cent (n = 25/74) and 50.6 per cent (n = 90/178) following referral refinement. The first visit discharge (false positive) rate was 26 per cent (n = 19/74) for community referrals compared to four per cent (n = 8/178) with referral refinement. Positive predictive value increased with the number of abnormal clinical examination findings associated with referral (χ2 test, p < 0.0001). The number of abnormal findings reported in referrals was significantly higher with referral refinement compared to without (n = 1.9 versus 1.5, t‐test, p < 0.0001).ConclusionReferral refinement can improve the diagnostic accuracy of optometry‐initiated referrals for glaucoma suspects in Australia, thereby decreasing unnecessary referrals to hospital and other secondary clinics.