Use Of Topical Antiglaucoma Medications Research Articles

Clinical profile, demographic distribution, and management of Posner-Schlossman syndrome: An electronic medical record-driven data analytics from an eye care network in India.

To describe the clinical profile, demographics, and management of Posner-Schlossman syndrome (PSS) in patients presenting to a multitier ophthalmology hospital network in India. This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PSS in at least one eye were included as cases. The data were collected using an electronic medical record system. Overall, 130 eyes of 126 (0.004%) patients were diagnosed with PSS. The majority of the patients were male (81.75%) and had unilateral (96.83%) affliction. The most common age group at presentation was during the fourth decade of life, with 46 (36.5%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.005%) presenting from the metropolitan geography (0.008%) and in professionals (0.014%). A significant number of patients (108; 83.08%) had a raised intraocular pressure of >30 mm of Hg. The majority of the eyes had mild or no visual impairment (better than 20/70) in 99 (76.15%) eyes. Keratic precipitates were found in 59 (45.38%) eyes, anterior chamber cells in 43 (33.08%) eyes, and iris atrophy in seven (5.38%) eyes. The majority of eyes (127; 97.69%) had open angles on gonioscopy. The average duration of use of topical steroids was 1.70 ± 0.76 months, and the average duration of use of topical antiglaucoma medications (AGMs) was 1.66 ± 0.81 months, with 35 eyes (26.92%) requiring continued AGMs. Among the surgical interventions, trabeculectomy was performed in nine (6.92%) eyes and cataract surgery in five (3.85%) eyes. PSS more commonly affects males presenting during the fourth decade of life from higher socioeconomic status and is predominantly unilateral. The majority of the eyes have mild or no visual impairment, open angles, and require surgical intervention in a tenth of the eyes.

Clinico-cytological analysis of conjunctiva and ocular surface symptoms of patients on topical anti-glaucoma medications attending Lagos University Teaching Hospital, Lagos, Nigeria: A case-control study.

The long-term use of topical anti-glaucoma medications is often associated with ocular surface toxicity that can affect the patient's drug compliance and quality of life. This study assessed the effect of these medications, using cytological changes of the conjunctiva and ocular surface symptoms. This was a clinic-based, case-control study that was conducted at the Lagos University Teaching Hospital that compared glaucoma patients on topical medications with age-sex-matched controls. The controls were non-glaucoma patients, who were not on any topical ocular medications at least 6 months prior to the study. The Ocular Surface Disease Index (OSDI) questionnaire was used to assess ocular surface symptoms. Schirmer's I test, tear film break-up time (TBUT) test and corneal fluorescein staining of the ocular surface were used for ocular surface disease (OSD) assessment and conjunctival impression cytology (CIC) for histological assessment and grading. Six hundred and ninety-six eyes of 348 respondents, 174 cases and 174 controls, were assessed for OSD. The mean ages of the case and control groups were 56.3 ± 12.9 years and 55.5 ± 13.2 years, respectively, with no statistical difference (P = 0.589). All ocular parameters assessed were significantly abnormal in the case group compared to the control group. The use of topical anti-glaucoma medications was significantly associated with abnormal TBUT (P < 0.001), Schirmer's test (P < 0.001), ocular surface staining (P < 0.001), CIC (P < 0.001) and OSDI scores (P = 0.001). A significant association was seen between abnormal TBUT and the number of medications (P = 0.044, odds ratio [OR] =0.79, 95% confidence interval [CI]: 0.44-1.14), between abnormal ocular surface staining and duration of anti-glaucoma medications usage (P = 0.0104, OR = 1.2, 95% CI: 1.04-1.43) and between abnormal CIC and the duration of anti-glaucoma medications (P = 0.0007, OR = 0.7, 95% CI: 0.59-0.86). The study demonstrates that prolonged use of topical anti-glaucoma medications may be associated with damage to the ocular surface structures.

Incidence of Primary Punctal Stenosis in Adult Patients with Epiphora

Abstract Background Punctal stenosis is one of the etiologies of epiphora, which is caused by an anatomical narrowing or occlusion of the external opening of the lacrimal canaliculi. Punctal stenosis is graded according to punctal sizes examined under slit-lamp biomicroscopy into grade 0 (could not find papilla and punctum), grade 1: Papilla is covered by a membrane (exudative or true membrane), grade 2: Smaller than normal size but recognizable, grade 3: normal, grade 4: Small slit (&amp;lt;2 mm) and grade 5: Large slit (&amp;gt;2 mm). Objective To assess the incidence of punctal stenosis in adult patients with epiphora attending outpatient’s ophthalmology clinic at Ain Shams University Hospital during the months of January and February 2020. Patients and Methods This is an observational study, conducted at the Ophthalmology Outpatient Clinic, Ophthalmology Department, Ain Shams University, using non-probability (convenience) sample. It included all patients above 18 years old who presented to the Ophthalmology Outpatient Clinic during the months of January and February 2020 with tearing, proved to be epiphora on clinical examination. Results Thirty one patients, out of 1800 patients attending the Outpatient Ophthalmology Clinic during the study period had epiphora with incidence of 1.6 %. Incidence of punctal stenosis was reported to be 68.4%. Other reported causes of epiphora were: Canaliculitis (3.5%), chronic dacrocystitis (5.3%), lacrimal sac mucocele (1.8%) and lower lid laxity (21.1%). Punctal stenosis was more common in females (61.5%) with mean age 58.55 years ± 11.67 SD. Punctal stenosis usually presented as bilateral (93.3%). Regarding ocular history 41% of cases were on topical anti glaucoma treatments. Most patients were medically free (54%). Conclusion Incidence of epiphora was 1.6% out of patients attending ASU Ophthalmology Outpatient Clinic. Punctal stenosis incidence was reported to be 68.4%. Most of the cases were females, above 63 years, grade one was the most common, with significant association with the long term use of topical anti-glaucoma medications.

Outcome of trabeculectomy versus Ahmed glaucoma valve implantation in the surgical management of glaucoma in patients with Sturge–Weber syndrome

AimsTo compare the surgical outcomes of trabeculectomy versus Ahmed glaucoma valve (AGV) implantation in the surgical management of glaucoma in patients with Sturge–Weber syndrome (SWS).MethodsA retrospective chart review was performed...

Risk factors for depressive symptoms in glaucoma patients: a nationwide case-control study.

The purpose was to investigate the risk factors for depressive symptoms in glaucoma patients. From the Longitudinal Health Insurance Database in Taiwan, we included 1190 glaucoma patients with subsequent depression diagnoses in the case group and randomly selected 4673 glaucoma patients without depression diagnoses as the control group, matched by age, sex, and time of glaucoma diagnosis. The age-adjusted Charlson comorbidity index (ACCI) score was used to compute the burden of comorbidity for each patient. Current use (past 6 months) of topical antiglaucoma medications and systemic medications was identified. Multivariate regression was used to analyze the risk factors for depression. The mean age for glaucoma patients was 61.88 years. Patients with depressive symptoms had significantly higher ACCI scores (P < .0001). The current use of any topical antiglaucoma medications was not associated with an increased risk for depression. However, higher ACCI scores (P < .0001), cerebrovascular diseases (odds ratio [OR] = 1.324, 95 % confidence interval [CI] = 1.118--1.568), dementia (OR = 2.647, 95 % CI = 2.142-3.270), thyroid diseases (OR = 1.720, 95 % CI = 1.366-2.165), headaches (OR = 1.299, 95 % CI = 1.112-1.518), and current use of systemic β-blockers (OR = 1.782, 95 % CI = 1.538-2.065) and calcium channel blockers (OR = 1.396, 95 % CI, 1.197-1.629) were found to increase the risk of depression in glaucoma patients. In this study, a comorbidity burden was a significant risk factor for depression in glaucoma patients, particularly for those currently using systemic β-blockers and calcium channel blockers.

Brimonidine reduces TGF-beta-induced extracellular matrix synthesis in human Tenon’s fibroblasts

BackgroundBrimonidine is a highly selective α2 adrenergic agonist that has been widely used in anti-glaucoma eyedrops. The aim of this study was to investigate its putative anti-fibrotic role in the fibrosis caused by activated Tenon’s fibroblasts.MethodsPrimary cultured human Tenon’s fibroblasts were exposed to 2.0 ng/mL of transforming growth factor-β1 (TGF-β1) for up to 48 h. In the presence of various concentrations of brimonidine (from 0.0 to 10.0 μM), the expression levels of fibronectin, collagen types I and III, and β-actin were determined by Western immunoblots. The expression of phosphorylated SMAD2/3 (p-SMAD2/3) was then evaluated using immunofluorescence.ResultsTGF-β1 significantly increased the synthesis of fibronectin and collagens in human Tenon’s fibroblasts; however brimonidine treatment distinctly attenuated the TGF-β1-induced production of extracellular matrix (ECM) proteins. TGF-β1 also changed the cellular morphology to be plump, while brimonidine treatment returned the cells to a spindle shape, similar to control fibroblasts. Regarding p-SMAD2/3, brimonidine treatment did not show any apparent changes in its expression.ConclusionsOur data revealed that brimonidine reduces TGF-β-induced ECM synthesis in human Tenon’s fibroblasts in vitro. This finding implies that topical administration of brimonidine may be helpful in reducing the fibrosis caused by the long-term use of topical anti-glaucoma medications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-015-0045-8) contains supplementary material, which is available to authorized users.

Intracameral Ranibizumab and Subsequent Mitomycin C Augmented Trabeculectomy in Neovascular Glaucoma

The purpose of this study is to evaluate the efficacy of intracameral ranibizumab (ICR) injections with subsequent mitomycin C (MMC) augmented trabeculectomy in the management of neovascular glaucoma (NVG). This is a prospective, interventional study of NVG, with research conducted between January 2010 and February 2011, at the Ophthalmology Department of Kasr El-Aini Hospital and Petrol Medical Center (Cairo, Egypt). Fifteen patients with NVG were included in the study, all of whom received intracameral ranibizumab (ICR) injections (0.5 mg) into their eyes 4 weeks before MMC augmented trabeculectomies were performed. All patients were followed up for a period of 6 months. Thirteen eyes (86.7%) achieved absence of clinically apparent iris neovascularization after 1 ICR injection and 2 eyes (13.3%) after a second injection. Eight eyes (53.3%) achieved complete success [if the intraocular pressure (IOP) was between 10 and 21 mm Hg] without topical antiglaucoma medications, 6 eyes (40%) had qualified success (if the IOP was within the same range) but with topical antiglaucoma medications, and failure occurred in 1 eye (6.7%) (because the IOP was above 21 mm Hg) despite the use of topical antiglaucoma medications. An ICR injection with subsequent MMC augmented trabeculectomy seems to be an effective combined technique in controlling IOP in eyes with NVG.

Long-Term Topical Antiglaucoma Medications Cause Enhanced Tenon’s Capsule Fibroblast Proliferation and Abnormal TGF-β and MMP Expressions: Potential Effects on Glaucoma Filtering Surgery

To investigate the changes in Tenon's capsule fibroblast (HTF) proliferation and their expressions of transforming growth factor-β (TGF-β) and matrix metalloproteinases (MMPs) in patients with long-term use of topical antiglaucoma medications, and to evaluate the potential effect of these medications on the outcome of glaucoma filtering surgery for primary open-angle glaucoma (POAG). HTFs isolated from the conjunctiva of ten POAG patients and ten control patients with cataract or retinal detachment were tested for their in vitro proliferation capacity. RT-PCR (reverse-transcription polymerase chain reaction) was performed to detect the expressions of TGF-β and MMP mRNAs in the HTFs, and the expression of TGF-β2 protein was detected immunohistochemically. Enzyme-linked immunosorbent assay (ELISA) was used to detect the expression of TGF-β1 in the supernatant of the HTFs treated with the topical antiglaucoma agents. The HTFs from the POAG patients showed significantly higher proliferative activity than those from the control patients (P = 0.0013). The HTFs in the POAG group showed significantly higher expressions of TGF-β2 and TGF-β3 mRNA and lower MMP-9 mRNA than the control HTFs. MMP-3 mRNA was not detected in the HTFs in POAG groups, but lowly expressed in the control HTFs. The HTFs in the POAG group had a significantly higher expression of TGF-β2 protein; TGF-β1 protein was not detected in the control HTFs, but was highly expressed in the POAG group. Treatment of the HTFs with latanoprost resulted in a 4-fold increase in TGF-β1 expression in both groups, which was comparable for the expression after the exposure. Long-term use of some topical antiglaucoma medications might be associated with enhanced HTF proliferation and abnormal expressions of TGF-β and MMPs, which might have promoted scarring of the filtering blebs following glaucoma filtering surgery.

The effect of topical cholinergic medications on human Tenon's capsule fibroblasts in tissue culture.

The prior long-term use of topical anti-glaucoma medications has been suggested as an adverse factor for the outcome of trabeculectomy. The mechanism of action is not known. This study investigates the effect of cholinergic medications on the proliferation and viability of human Tenon's capsule fibroblasts in tissue culture to see whether this may be one mechanism by which increased surgical failure occurs. We examined the effect of two commercial pilocarpine products, pure pilocarpine hydrochloride, and pure benzalkonium chloride, at various dilutions, on the proliferation (as assessed by 3H-thymidine uptake) and viability (assessed microscopically) of human Tenon's capsule fibroblasts in tissue culture. None of the tested compounds stimulated the proliferation of fibroblasts in tissue culture. Three of the compounds inhibited proliferation, and all compounds had toxic effects on cell morphology. At equivalent dilutions of commercially available concentration, pure benzalkonium chloride and the commercial product containing it appeared more toxic and antiproliferative to cells in culture than pure pilocarpine hydrochloride and the preservative-free commercial product. These results show an antiproliferative and toxic effect of medications on fibroblasts in tissue culture. They do not support the theory that topical medications directly stimulate fibroblast proliferation. The possible relevance of these results for the outcome of glaucoma surgery is discussed.

Effect of TNF, IL-1, and IL-6 on the proliferation of human Tenon's capsule fibroblasts in tissue culture.

Trabeculectomy is a commonly performed procedure for primary open angle glaucoma and is successful in the majority of cases. However, certain factors including aphakia, previous surgery, secondary glaucomas, ethnic origin, and the long term use of topical antiglaucoma medications may be associated with a reduced success rate. The mechanism (or mechanisms) which influence clinical outcome following trabeculectomy remain elusive. Alterations in the composition of the conjunctiva or aqueous humour may be partly responsible for this effect, and this could be mediated by cytokines. In this study we found that tumour necrosis factor (TNF), and interleukin 1 (IL-1) were capable of stimulating the proliferation of Tenon's capsule fibroblasts in tissue culture. Interleukin 6 (IL-6) did not appear to have any effect. The relevance of this to wound healing following trabeculectomy is discussed.

Pilot study on the effect of topical adrenergic medications on human Tenon's capsule fibroblasts in tissue culture.

Recent publications have suggested that the long term use of topical antiglaucoma medications may be detrimental to the outcome of trabeculectomy. In order to investigate this further, the effect of several adrenergic agents and a preservative on the proliferation and viability of human Tenon's capsule fibroblasts in tissue culture were examined. The following compounds were tested: adrenaline (Eppy 1% and pure adrenaline base 1%, Smith & Nephew Pharmaceuticals Ltd); dipivefrine hydrochloride (Propine 0.1% and pure dipivefrine hydrochloride 0.1% Allergan Ltd and Allergan Pharmaceuticals (Ireland) Ltd); benzalkonium chloride (pure benzalkonium chloride 0.01%, Sigma Chemical Company Ltd); the two adrenaline based preparations were also tested in the presence of an antioxidant. None of the tested compounds stimulated the proliferation of fibroblasts. The commercial products tested, their pure compounds, and the preservative all inhibited proliferation and had toxic effects on the cells. In the presence of antioxidant, commercial Eppy and pure adrenaline base appeared to have less effect on proliferation and toxicity. These findings are discussed with reference to the outcome of trabeculectomy.