Hyperemia reduction after administration of a fixed combination of bimatoprost and timolol maleate to patients on prostaglandin or prostamide monotherapy.

OBJECTIVE: The aim of this study was to evaluate the change in hyperemia and intraocular pressure (IOP) in patients who switch from prostaglandin or prostamide to a fixed combination of prostamide and timolol maleate. DESIGN: A multicenter, longitudinal, noncontrolled, nonrandomized open trial was conducted. PARTICIPANTS: One hundred forty-four patients (282 eyes) were selected: 60 (41.6%) were on travaprost, 51 (35.4%) on bimatoprost, and 33 (22.9%) on latanoprost. All patients included were unable to attain adequate IOP control with monotherapy and had no contraindications to ß-blockers. INTERVENTION: Patients were treated with a fixed combination of bimatoprost and timolol maleate. Hyperemia was evaluated using a referential table, and IOP was measured at 8:00, 12:00, and 16:00 h both before and after 4 months of treatment. MAIN OUTCOME: IOP and hyperemia were compared at 2 time points: pretreatment and after 4 months. The mean of the 3 IOP measurements taken at various points during the day was considered for analysis. Generalized estimating equations were used for repeated measures and intereye dependency adjustments. RESULTS: Hyperemia and IOP were reduced in all 3 groups, with the same pattern for both eyes. The bimatoprost group had the highest levels of hyperemia before treatment when compared with the latanoprost as well as the travaprost group and had the greatest reduction in hyperemia after treatment (P < 0.01). Regarding IOP, all 3 groups had a significant reduction (P < 0.001), but the bimatoprost group had a lower pretreatment IOP when compared with the travaprost and latanoprost groups. CONCLUSION: A significant reduction in hyperemia was found after switching from monotherapy with prostaglandins or prostamide to a fixed combination of prostamide and a ß-blocker. IOP reduction was significant after the intervention in all 3 groups.

Efficacy and safety of trabeculectomy with mitomycin C for childhood glaucoma: a study of results with long-term follow-up.

OBJECTIVE: To evaluate the safety and effectiveness of trabeculectomy with mitomycin C in the management of childhood glaucoma. INTRODUCTION: The use of antifibrotic agents enhances the success of trabeculectomy performed in both adults and children. METHODS: A retrospective chart review (1991-2001) of 114 patients (114 eyes) from 0-14 years of age with congenital or developmental glaucoma. These patients underwent trabeculectomy with mitomycin but had not been previously treated with any antifibrotic agent. RESULTS: The mean patient age was 57.36+/-51.14 months (range: 0.5-168 months). Treatment was considered successful in 63 eyes (55.26%), with a mean intraocular pressure of 12.11+/-3.98 mmHg. For patients categorized as successfully treated, the mean follow-up time was 61.16+/-26.13 months (range 12-113 months). A post-surgical intraocular pressure of <16 was observed in 47 eyes. The life-table success rates for intraocular pressure control at 24, 36, 48, and 60 months were 90.2%, 78.7%, 60.7% and 50.8%, respectively. The cumulative probability of failure was 40.8% at 12 months. Following surgery, endophthalmitis appeared in eight eyes (4.88%) after an average 36.96 months (range: 1.7-106 months). Other complications included expulsive hemorrhage, flat anterior chamber and bleb leak. DISCUSSION: It has been reported in pediatric patients that trabeculectomy without adjunctive antimetabolites achieves a successful outcome in 30% to 50% of cases. In our study, treatment was considered successful in 63 eyes (55.26%) within 61.16+/-26.13 months of follow-up. CONCLUSIONS: Trabeculectomy with mitomycin is safe and effective for short-term or long-term treatment of congenital or developmental glaucoma. The frequency of bleb-related endophthalmitis was no higher in these patients than that described in adults.

Intraocular pressure fluctuations in response to the water-drinking provocative test in patients using latanoprost versus unoprostone.

Impairment of outflow facility in glaucoma causes large intraocular pressure (IOP) fluctuations that have been shown to be a risk factor for disease progression. The water-drinking provocative test (WDT) has been proposed as an indirect measurement of outflow facility to compare intraocular pressure responses of glaucoma eyes to different drugs. This study was a double-masked, randomized, parallel-group clinical trial comparing the IOP fluctuations in response to the WDT in patients using latanoprost versus unoprostone. After completing a wash-out of ocular hypotensive medications, patients with primary openangle glaucoma or ocular hypertension were randomized to receive either latanoprost (N=40) or unoprostone (N=42). IOP was measured before treatment and at 8 weeks after treatment (baseline IOP for WDT), followed by the WDT. IOP fluctuations and maximum IOP after water ingestion were compared between the two groups. Analysis of covariance was used to adjust for the effects of baseline IOP and treatment efficacy. The mean percentage reduction of IOP was 27% in patients using latanoprost, as compared to 13% in patients using unoprostone (p<0.001). Patients on treatment with latanoprost had significantly less IOP fluctuations in response to the WDT, compared to patients using unoprostone. From an overall baseline IOP of 20.0 mmHg and an overall treatment efficacy of 20%, the mean+/-standard error of the mean (SEM) of the IOP fluctuation during the WDT was 5.3+/-0.4 mmHg in the unoprostone group, and 3.6+/-0.4 mmHg in the latanoprost group (p=0.005, ANCOVA). This could represent an additional benefit of latanoprost over unoprostone in controlling the intraocular pressure of glaucomatous patients.

Volume da gota de medicamentos antiglaucomatosos / Drop volume of glaucoma medications

Avaliar o volume da gota de alguns medicamentos antiglaucomatosos comumente prescritos. Local: Serviço de glaucoma, clínica oftalmológica, Hospital das Clínicas da FMUSP. Método: Contou-se o conteúdo em gotas de oito produtos hipotensores oculares: brimonidina 0,2 por cento (Alphagan, lab. Allergan), brinzolamida 1,0 por cento (Azopt, lab. Alcon), betaxolol 0,25 por cento (Betoptic-S, lab. Alcon), timolol 0,5 por cento + dorzolamida 2 por cento (Cosopt, lab. Merck), unoprostona (Rescula, lab. Ciba), timolol 0,5 por cento (Timoptol 0,5 por cento, lab. Merck), dorzolamida 2 por cento (Trusopt, lab. Merck) e latanoprost 0,005 por cento (Xalatan, lab. Pharmacia). Utilizou-se 6 frascos para cada medicamento, calculando-se o volume médio da gota de cada um deles como também para o grupo como um todo. Examinou-se as diferenças nos volumes de gotas entre os oito produtos. Resultados: O volume médio da gota para o grupo dos oito medicamentos foi 35,80ñ10,38ml. Foram encontradas, contudo, diferenças significativas entre eles: Xalatan exibiu o menor volume de gota, com 23,81ml, enquanto que Betoptic-S, com 56,50ml, o maior. O volume da gota de todas as outras medicações não diferiu significativamente da média geral. Conclusão: O volume médio de gota para o grupo das oito drogas mostrou ser maior que o necessário, apontando para desperdício. Suponso uso de uma gota por instilação, um frasco de Betoptic-S duraria 22,2 dias (dois olhos tratados, 2 vezes ao dia), enquanto que um de Xalatan duraria 52,5 dias (dois olhos tratados, 1 vez ao dia).