Comparison of the efficacy and safety of latanoprost 0.005% compared to brimonidine 0.2% or dorzolamide 2% when added to a topical beta-adrenergic blocker in patients with primary open-angle glaucoma or ocular hypertension.

The purpose of this study was to evaluate the ocular hypotensive efficacy and safety of latanoprost 0.005% (Xalatan, Pharmacia & Upjohn), brimonidine (Alphagan, Allergan), and dorzolamide (Trusopt, Merck Inc.) when added to a beta-blocker in patients with ocular hypertension or primary open-angle glaucoma. This was a multicenter, retrospective analysis which included all reviewed patient records in which latanoprost, brimonidine or dorzolamide were added to a beta-blocker for at least three months. Patients who were treated for less than three months, who failed therapy due to ineffectiveness of the medicine or an adverse event also were included. The study included 141 patients. Latanoprost (n = 50) showed an intraocular pressure of 16.7 +/- 3.3 mm Hg (-6.3 +/- 4.1 mm Hg, P < 0.001), brimonidine (n = 24) 17.4 +/- 4.9 mm Hg (-4.2 +/- 4.5 mm Hg, P < 0.001), and dorzolamide (n = 67) 20.1 +/- 6.1 mm Hg (-3.1 +/- 5.1 mm Hg, P < 0.001) at three months. A significant difference was observed in the absolute level of intraocular pressure (P < 0.005) and the change from baseline between groups (P < 0.005) at three months. A significant difference was observed between groups in the success rate of therapy between latanoprost (70%), brimonidine (58%) and dorzolamide (40%) (P = 0.008). No significant differences were observed between groups for rate or type of adverse events leading to discontinued therapy. This study showed that latanoprost, when added to beta-blockers, compares favorably in ocular hypotensive efficacy and is similar in safety to brimonidine and dorzolamide.

The heredity and treatment of angle-closure glaucoma secondary to iris and ciliary body cysts.

Three families with peripheral iris and ciliary body cysts are described. The cysts were multiple in 10 of the 11 affected patients, and they were bilateral in 8 of the 11. Angle closure glaucoma secondary to the cysts was present in 4 of the 11 cases. The management of this glaucoma requires a high index of suspicion, careful gonioscopic evaluation and proper medical and/or surgical treatment. Laser therapy for the angle closure caused by pigmented cysts may be curative. Nonpigmented ciliary body cysts are refractory to argon laser treatment and carry a poor prognosis. The cases described suggest an autosomal dominant hereditary pattern. The importance of examination and follow up of healthy relatives of patients with iris and ciliary body cysts is stressed, as early detection and treatment by laser cystotomy may prevent or cure angle closure glaucoma if the disease is diagnosed prior to the establishment of synechial closure.

Primary radiation therapy for meibomian gland carcinoma.

Three patients with Meibomian gland carcinoma were treated initially with irradiation. This therapy was palliative in one case that eventually required orbital exenteration because of recurrent disease. A second patient was clinically tumor-free ten months after treatment when he died of a myocardial infarction. The third patient has shown no evidence of recurrent disease in the 25 months since treatment.

Fluorescein angiographic defects of the optic disc in glaucoma.

An improved technique for high-contast, high-resolution fluorescein angiography of the optic disc has been developed that almost eliminates pseudofluorescence. Fluorescein angiography of the optic disc was performed on normal, ocular hypertensive, and glaucomatous patients. Rapid-sequence angiograms in the early arterial phases have demonstrated localized areas of hypofluorescence or filling defects of the optic disc. Two types of fluorescein filling defects were observed-absolute and relative. The number of absolute filling defects, which increased with degree of visual field loss, was greater in glaucomatous than in ocular hypertensive or normal eyes. Similarly, ocular hypertensive eyes showed a larger number of discs with filling defects than normal eyes. It is postulated that relative defects progress to absolute filling defects, which may be an indication of impending loss of visual field.