RESUMO
Glaucoma is a group of eye diseases consisting of optic nerve damage with corresponding loss of field vision and blindness. Hydrogen sulfide (H2S) is a gaseous neurotransmitter implicated in various pathophysiological processes. It is involved in the pathological mechanism of glaucomatous neuropathy and exerts promising effects in the treatment of this disease. In this work, we designed and synthetized new molecular hybrids between antiglaucoma drugs and H2S donors to combine the pharmacological effect of both moieties, providing a heightened therapy. Brinzolamide, betaxolol and brimonidine were linked to different H2S donors. The H2S-releasing properties of the new compounds were evaluated in a phosphate buffer solution by the amperometric approach, and evaluated in human primary corneal epithelial cells (HCEs) by spectrofluorometric measurements. Experimental data showed that compounds 1c, 1d and 3d were the hybrids with the best properties, characterized by a significant and long-lasting production of the gasotransmitter both in the aqueous solution (in the presence of L-cysteine) and in the intracellular environment. Because, to date, the donation of H2S by antiglaucoma H2S donor hybrids using non-immortalized corneal cells has never been reported, these results pave the way to further investigation of the potential efficacy of the newly synthesized compounds.
Assuntos
Gasotransmissores , Glaucoma , Sulfeto de Hidrogênio , Humanos , Agentes Antiglaucoma , Betaxolol/farmacologia , Betaxolol/uso terapêutico , Gasotransmissores/uso terapêutico , Glaucoma/tratamento farmacológico , Sulfeto de Hidrogênio/farmacologia , Sulfeto de Hidrogênio/uso terapêuticoRESUMO
BACKGROUND: Beta-blockers have gradually become an attractive option for the treatment of infantile hemangiomas. Topical application is preferred to oral administration because of their potential systemic adverse effects. The aim of this study is to investigate the effect of betaxolol in treating superficial infantile hemangioma. METHODS: Seventy-four infants admitted to the First Affiliated Hospital of Xinjiang Medical University from 2018 to 2019 were observed and recorded. Variables such as color, size, tension, and thickness were recorded monthly and evaluated using visual analog scales. Multi-factor analysis of variance with repeated measurements and the non-parametric Kruskal-Wallis H test were used to compare clinical effectiveness across the different groups. RESULTS: After 6 months of treatment, 33.78% (25/74) showed excellent results, 55.41% (41/74) had good responses, 8.11% (6/74) had moderate responses, and 2.70% (2/74) had poor responses. Local discomfort and systemic complications were not found. There was no significant difference in gender and location of occurrence among groups (p > 0.05), and the effect of topical application of betaxolol was optimum in the children aged 0-3 months (p = 0.002). None of three age groups had statistically significant difference in heart rate and blood pressure after accepting treatment (1 month, p = 0.618; 4 months, p = 0.138; 6 months, p = 0.757). CONCLUSIONS: Our study showed that topical administration of betaxolol was effective and well tolerated for superficial infantile hemangiomas, particularly in the early proliferative stage. However, its safety and efficacy need further research.
Assuntos
Hemangioma Capilar , Hemangioma , Neoplasias Cutâneas , Lactente , Criança , Humanos , Timolol/efeitos adversos , Hemangioma/tratamento farmacológico , Projetos Piloto , Betaxolol/uso terapêutico , Hemangioma Capilar/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Resultado do Tratamento , Neoplasias Cutâneas/tratamento farmacológicoRESUMO
BACKGROUND/AIMS: To 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). METHODS: A systematic literature review adapted from the Li et al (Ophthalmology, 2016) study was conducted. Medline, Embase and PubMed were searched for randomised controlled trials published between 1 January 2014 and 19 March 2020. Studies had to report IOP reduction after 3 months for at least two different treatments among placebo, PGAs (bimatoprost 0.01%, bimatoprost 0.03%, latanoprost, LBN, tafluprost, unoprostone) or apraclonidine, betaxolol, brimonidine, brinzolamide, carteolol, dorzolamide, levobunolol, timolol, travoprost. A Bayesian network meta-analysis was performed to provide the relative effect in terms of mean difference (95% credible interval) of IOP reduction and ranking probabilities. Surface under the cumulative ranking curve (SUCRA) was generated. RESULTS: A total of 106 trials were included with data for 18 523 participants. LBN was significantly more effective than unoprostone (-3.45 (-4.77 to -2.12)). Although relative effect was not significative, compared with other PGAs, LBN numerically outperformed latanoprost (-0.70 (-1.83 to 0.43)) and tafluoprost (-0.41 (-1.87 to 1.07)), was similar to bimatoprost 0.01% (-0.02(-1.59 to 1.55)) and was slightly disadvantaged by bimatoprost 0.03% (-0.17 (-1.42 to 1.07)). LBN was significantly more efficient than the beta-blockers apraclonidine, betaxolol, brimonidine, brinzolamide, carteolol, dorzolamide and timolol. According to SUCRA, LBN was ranked second after bimatoprost 0.03%, followed by bimatoprost 0.01%. CONCLUSION: LBN was significantly more effective than the PGA unoprostone and most of the beta-blockers. Compared with the most widely used PGAs, LBN numerically outperformed latanoprost and travoprost and was similar to bimatoprost 0.01%.
Assuntos
Carteolol , Glaucoma de Ângulo Aberto , Hipertensão Ocular , Prostaglandinas F Sintéticas , Amidas/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Teorema de Bayes , Betaxolol/uso terapêutico , Bimatoprost/uso terapêutico , Tartarato de Brimonidina/uso terapêutico , Carteolol/uso terapêutico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Pressão Intraocular , Latanoprosta , Metanálise em Rede , Hipertensão Ocular/tratamento farmacológico , Prostaglandinas A/uso terapêutico , Timolol/uso terapêutico , Travoprost/uso terapêuticoRESUMO
CLINICAL RELEVANCE: Posterior capsule opacification is a common late complication of cataract surgery. Posterior capsule opening with Nd:YAG laser, which is the standard treatment, may cause transient elevation of intraocular pressure (IOP). BACKGROUND: To evaluate the efficacy of betaxolol 0.|5% compared to brimonidine 0.2%, in prevention of intraocular pressure increase after Nd:YAG Laser posterior capsulotomy. METHODS: In a double masked randomised clinical trial, 38 eyes from 38 pseudophakic patients over 21 years of age who had significant posterior capsule opacification after phacoemulsification were randomly assigned to receive either betaxolol 0.|5% (18 eyes) or brimonidine 0.|2% (20 eyes) one hour before Nd:YAG Laser posterior capsulotomy.| Exclusion criteria were: glaucoma or history of glaucoma surgery, active uveitis, active ocular infection, pregnancy, unstable cardiovascular condition and severe asthma and lung diseases. Intraocular pressure was measured by Goldmann applanation tonometry, 1 hour before applying the laser and 4 hours after the laser application. RESULTS: There was no statistically significant difference between the two groups regarding the baseline mean IOP and the 4-hour post-laser mean IOP. There was a statistically significant decrease in the 4-hour post-laser mean IOP as compared to the baseline mean IOP in each group. The mean IOP change in the betaxolol group, was -2.39 ± 1.79 mm Hg and in the brimonidine group was -4.25 ± 2.20 mm Hg. The difference was statistically significant (P = 0.007). None of the patients experienced clinically significant IOP increase (≥5 mm Hg) in either group. CONCLUSION: Use of a single topical dose of betaxolol 0.5% and brimonidine 0.2%, 1 hour before laser treatment, can prevent significant acute IOP increase after Nd:YAG laser posterior capsulotomy, and betaxolol may provide a new alternative for prophylactic use.
Assuntos
Opacificação da Cápsula , Glaucoma , Cápsula do Cristalino , Hipertensão Ocular , Humanos , Pressão Intraocular , Tartarato de Brimonidina/uso terapêutico , Betaxolol/uso terapêutico , Opacificação da Cápsula/cirurgia , Hipertensão Ocular/etiologia , Hipertensão Ocular/prevenção & controle , Capsulotomia Posterior/efeitos adversos , Glaucoma/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controleRESUMO
Up-regulation of utrophin in muscles represents a promising therapeutic strategy for the treatment of Duchenne Muscular Dystrophy. We previously demonstrated that eEF1A2 associates with the 5'UTR of utrophin A to promote IRES-dependent translation. Here, we examine whether eEF1A2 directly regulates utrophin A expression and identify via an ELISA-based high-throughput screen, FDA-approved drugs that upregulate both eEF1A2 and utrophin A. Our results show that transient overexpression of eEF1A2 in mouse muscles causes an increase in IRES-mediated translation of utrophin A. Through the assessment of our screen, we reveal 7 classes of FDA-approved drugs that increase eEF1A2 and utrophin A protein levels. Treatment of mdx mice with the 2 top leads results in multiple improvements of the dystrophic phenotype. Here, we report that IRES-mediated translation of utrophin A via eEF1A2 is a critical mechanism of regulating utrophin A expression and reveal the potential of repurposed drugs for treating DMD via this pathway.
Assuntos
Distrofia Muscular de Duchenne/tratamento farmacológico , Fator 1 de Elongação de Peptídeos/antagonistas & inibidores , Biossíntese de Proteínas/efeitos dos fármacos , Utrofina/genética , Regiões 5' não Traduzidas/genética , Animais , Betaxolol/farmacologia , Betaxolol/uso terapêutico , Linhagem Celular , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Reposicionamento de Medicamentos , Humanos , Sítios Internos de Entrada Ribossomal/genética , Camundongos , Camundongos Endogâmicos mdx , Camundongos Knockout , Distrofia Muscular de Duchenne/genética , Mioblastos , Fator 1 de Elongação de Peptídeos/genética , Fator 1 de Elongação de Peptídeos/metabolismo , Pravastatina/farmacologia , Pravastatina/uso terapêutico , Biossíntese de Proteínas/genética , Regulação para Cima/efeitos dos fármacos , Utrofina/metabolismoRESUMO
Pyogenic granuloma (PG) is an acquired vascular growth on the skin and mucous membranes. Even though PG is a benign tumor, treatment is required due to associated risk of ulceration and bleeding, cosmetic concerns, and the low likelihood of spontaneous regression. Treatment entails excisional surgery, cryotherapy, or electrocautery; recurrence however is a major problem. Beta-blockers became an attractive option for the treatment of vascular growths after it got approved for infantile hemangioma. PG was found to express beta adrenergic receptors, similarly to infantile hemangioma. Several publications have reported the use of oral and topical beta blockers such as timolol, propranolol, and betaxolol for the treatment of PG. In this study, we summarized the literature with regards to the effectiveness of topical beta blockers for the treatment of PG, and discussed all published case reports, case series, and open-label single arm trials. J Drugs Dermatol. 2019;18(10):1006-1010.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Granuloma Piogênico/tratamento farmacológico , Dermatopatias/tratamento farmacológico , Administração Cutânea , Administração Oral , Betaxolol/uso terapêutico , Ensaios Clínicos como Assunto , Granuloma Piogênico/patologia , Humanos , Propranolol/uso terapêutico , Receptores Adrenérgicos beta/metabolismo , Recidiva , Pele/patologia , Dermatopatias/patologia , Timolol/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: To date, the rapid clearance from ocular surface has been a huge obstacle for using eye drops to treat glaucoma, since it has led to the short preocular residence time and low bioavailability. METHODS: The novel nanoparticles (NPs) were designed for topical ophthalmic controlled drug delivery system through intercalating the BH into the interlayer gallery of Na-montmorillonite (Na+Mt) and then further enchasing chitosan nanoparticles. The resulting nanoparticles had a positive charge (+29±0.18 mV) with an average diameter of 460±0.6 nm. RESULTS: In vitro study of drug release profiles suggested controlled release pattern. The irritation experiment analysis on both human immortalized cornea epithelial cell (iHCEC) and chorioallantoic membrane-trypan blue staining (CAM-TBS) showed good tolerance for ocular tissues. It was interestingly found that the nanoparticles could enter into iHCEC from the result of cellular uptake experiment measured by confocal layer scan microscopy (CLSM). Meanwhile, multilayered iHCEC was used to simulate the barrier of corneal epithelial cells for in vivo preocular retention capacity study, which suggested that BH-Mt/CS NPs could prolong the retention time in comparison with BH solution. The ocular pharmacokinetics studied by microdialysis sampling technique showed that AUC0-t and MRT0-t of BH-Mt/CS NPs were 1.99-fold and 1.75-fold higher than those of BH solution, indicating higher bioavailability. Moreover, the study of blood drug concentration, few researchers have reported, showed that low level drug could enter into blood, suggesting lower systematic side effect. Importantly, pharmacodynamics studies suggested that BH-Mt/CS NPs could make a significant decreased intraocular pressure on glaucomatous rabbits. CONCLUSION: Inspired by these advance of montmorillonite/chitosan nanoparticles, we envision that the BH-Mt/CS NPs will be a potential carrier for BH, opening up the possible applications in glaucoma therapy.
Assuntos
Bentonita/química , Betaxolol/administração & dosagem , Betaxolol/uso terapêutico , Quitosana/química , Sistemas de Liberação de Medicamentos , Glaucoma/tratamento farmacológico , Nanopartículas/química , Administração Tópica , Animais , Humor Aquoso/efeitos dos fármacos , Betaxolol/sangue , Betaxolol/farmacocinética , Sobrevivência Celular/efeitos dos fármacos , Córnea/efeitos dos fármacos , Córnea/patologia , Preparações de Ação Retardada/farmacologia , Preparações de Ação Retardada/uso terapêutico , Diálise , Portadores de Fármacos , Liberação Controlada de Fármacos , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/patologia , Glaucoma/patologia , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/efeitos dos fármacos , Nanopartículas/administração & dosagem , Nanopartículas/ultraestrutura , Soluções Oftálmicas/farmacologia , Tamanho da Partícula , Coelhos , Eletricidade EstáticaRESUMO
BACKGROUND: Glaucoma is a serious eye disease that can lead to loss of vision. Unfortunately, effective treatments are limited by poor bioavailability of antiglaucoma medicine due to short residence time on the preocular surface. MATERIALS AND METHODS: To solve this, we successfully prepared novel controlled-release ion-exchange microparticles to deliver betaxolol hydrochloride (BH). Montmorillonite/BH complex (Mt-BH) was prepared by acidification-intercalation, and this complex was encapsulated in microspheres (Mt-BH encapsulated microspheres [BMEMs]) by oil-in-oil emulsion-solvent evaporation method. The BH loaded into ion-exchange Mt was 47.45%±0.54%. After the encapsulation of Mt-BH into Eudragit microspheres, the encapsulation efficiency of BH into Eudragit microspheres was 94.35%±1.01% and BH loaded into Eudragit microspheres was 14.31%±0.47%. RESULTS: Both Fourier transform infrared spectra and X-ray diffraction patterns indicated that BH was successfully intercalated into acid-Mt to form Mt-BH and then Mt-BH was encapsulated into Eudragit microspheres to obtain BMEMs. Interestingly, in vitro release duration of the prepared BMEMs was extended to 12 hours, which is longer than both of the BH solution (2.5 hours) and the conventional BH microspheres (5 hours). Moreover, BMEM exhibited lower toxicity than that of BH solution as shown by the results of cytotoxicity tests, chorioallantoic membrane-trypan blue staining, and Draize rabbit eye test. In addition, both in vivo and in vitro preocular retention capacity study of BMEMs showed a prolonged retention time. The pharmacodynamics showed that BMEMs could extend the drug duration of action. CONCLUSION: The developed BMEMs have the potential to be further applied as ocular drug delivery systems for the treatment of glaucoma.
Assuntos
Bentonita/química , Sistemas de Liberação de Medicamentos , Glaucoma/tratamento farmacológico , Microesferas , Ácidos Polimetacrílicos/química , Animais , Betaxolol/farmacologia , Betaxolol/uso terapêutico , Disponibilidade Biológica , Morte Celular/efeitos dos fármacos , Membrana Corioalantoide/metabolismo , Preparações de Ação Retardada , Diálise , Emulsões/farmacologia , Células Epiteliais/patologia , Epitélio Corneano/patologia , Pressão Intraocular/efeitos dos fármacos , Troca Iônica , Coelhos , Espectroscopia de Infravermelho com Transformada de Fourier , Difração de Raios XAssuntos
Afatinib/efeitos adversos , Betaxolol/uso terapêutico , Granuloma Piogênico/induzido quimicamente , Granuloma Piogênico/tratamento farmacológico , Paroniquia/induzido quimicamente , Paroniquia/tratamento farmacológico , Administração Tópica , Afatinib/uso terapêutico , Receptores ErbB/antagonistas & inibidores , Feminino , Seguimentos , Granuloma Piogênico/fisiopatologia , Humanos , Paroniquia/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: Elevated heart rate (HR) increases cardiovascular morbidity and mortality in hypertension. The impact of beta-blockers on patient prognosis in hypertension is controversial. This study examined the age-related effects of betaxolol on HR, muscle sympathetic nerve activity (MSNA), blood pressure (BP) and sympathovagal balance in untreated males with hypertension and tachycardia. METHODS: Ten young (age 26 ± 1 years) and seven older (age 50 ± 4 years) males underwent measurement of BP, HR, HR variability (Poincare plot) and MSNA before and after 8 weeks treatment with betaxolol at the initial starting dose of 10 mg/day, which was increased to 20 mg/day once daily after 4 weeks in all subjects. RESULTS: In younger subjects, betaxolol decreased systolic BP (-13 ± 4 mm Hg, p = .01) and HR (-29 ± 4 bpm, p < .001) but not MSNA (3 ± 3 burst/min., p = 0.47) after 8 weeks. In older subjects a pronounced reduction in BP (-27 ± 7, p = .007) was accompanied by a significant decrease in MSNA (-13 ± 5 burst/min., p < .05) and HR (-17 ± 4 bpm, p = .002). SD1/SD2 ratio of Poincare plot increased in younger (0.36 ± 0.03 vs 0.51 ± 0.05, p = .004), but not in older (0.43 ± 0.08 vs 0.54 ± 0.12, p = .50) subjects. CONCLUSION: Autonomic neural responses to betaxolol are age-dependent in hypertension-related tachycardia. Betaxolol reduces sympathetic drive to the heart, but not to the peripheral vessels confirming the contribution of augmented cardiac sympathetic activity to disease pathophysiology in younger adults. In older hypertensives, the sympathovagal balance is not influenced by betaxolol. The paradoxical reduction in MSNA despite lowering of BP and HR in older patients may suggest age-related functional decrements in autonomic control and/or inhibitory effects of betaxolol on the central nervous system.
Assuntos
Fatores Etários , Betaxolol/farmacologia , Sistema Nervoso Simpático/efeitos dos fármacos , Simpatolíticos/farmacologia , Taquicardia/tratamento farmacológico , Antagonistas de Receptores Adrenérgicos beta 1/farmacologia , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Adulto , Betaxolol/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Músculos/inervaçãoRESUMO
PURPOSE: ß-adrenergic receptor antagonists (ß-blockers) used in the treatment of glaucoma are an often-overlooked source of systemic adverse events. Ophthalmic timolol has been associated with severe systemic adverse events including numerous cases resulting in death. In recent years the number of fixed-dose combination therapies for glaucoma has grown rapidly, and among available combination therapies only the nonselective ß-blocker timolol is used as the ß-blocker component. METHODS: A population-based study was conducted in Ontario, Canada between January 1, 2001 and December 31, 2012 to assess the shift to combination therapies in the management of glaucoma, and to investigate the impact of this shift on the relative use of selective and nonselective ß-blockers in patients with this disease. RESULTS: Between 2001 and 2012 timolol (nonselective ß-blocker) use grew at an average annual rate of 2.2% (P<0.0001), whereas betaxolol (selective ß-blocker) use declined by 14.1% per year (P<0.0001). These changes in the relative use of betaxolol and timolol coincided with changes in the relative use of combination and single-drug therapies. Over the study period, the use of ß-blockers as single-drug therapy decreased by 7.7% annually (P<0.0001). In contrast, the use of combination therapies containing a ß-blocker increased by 7.6% annually (P<0.0001). CONCLUSIONS: The introduction of fixed combination glaucoma therapies has been associated with a significant shift to greater use of nonselective ß-blockers. In vulnerable older populations, this may have an important impact on patient safety that warrants further study.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Betaxolol/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Glaucoma de Ângulo Aberto/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Timolol/uso terapêutico , Idoso , Combinação de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Soluções OftálmicasRESUMO
PURPOSE: To elucidate the temporal relationship between detection of glaucomatous optic disc progression, as assessed by fundus photography, and visual field progression. DESIGN: Prospective, randomized, longitudinal trial. PARTICIPANTS: Three hundred six study eyes with manifest glaucoma with field loss and 192 fellow eyes without any field defect at the start of the trial, from a total of 249 subjects included in the Early Manifest Glaucoma Trial (EMGT), were assessed. METHODS: Evaluation of visual field progression and optic disc progression during an 8-year follow-up period. Three graders independently assessed optic disc progression in optic disc photographs. Visual field progression was assessed using glaucoma change probability maps and the EMGT progression criterion. MAIN OUTCOME MEASURES: Time to detection of visual field progression and optic disc progression. RESULTS: Among study eyes with manifest glaucoma, progression was detected in the visual field first in 163 eyes (52%) and in the optic disc first in 39 eyes (12%); in 1 eye (0%), it was found simultaneously with both methods. Among fellow eyes with normal fields, progression was detected in the visual field first in 28 eyes (15%) and in the optic disc first in 34 eyes (18%); in 1 eye (1%), it occurred simultaneously. CONCLUSIONS: In eyes with manifest glaucoma, progression in the visual field was detected first more than 4 times as often as progression in the optic disc. Among fellow eyes without visual field loss at baseline, progression was detected first as frequently in the optic disc as in the visual field.
Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Transtornos da Visão/diagnóstico , Campos Visuais , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Idoso , Betaxolol/uso terapêutico , Terapia Combinada , Técnicas de Diagnóstico Oftalmológico , Progressão da Doença , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Glaucoma de Ângulo Aberto/terapia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Fotografação , Estudos Prospectivos , Fatores de Tempo , Trabeculectomia , Testes de Campo VisualRESUMO
Rieger syndrome (RS) is a multiple malformation syndrome characterized by ocular manifestations and extraocular defects. Herein, we report a 9-year-old boy who exhibited Rieger Syndrome phenotype as well as congenital hypothyroidism which may be an underappreciated feature of RS.
Assuntos
Segmento Anterior do Olho/anormalidades , Hipotireoidismo Congênito/complicações , Anormalidades do Olho/complicações , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Betaxolol/uso terapêutico , Criança , Hipotireoidismo Congênito/diagnóstico , Anormalidades do Olho/diagnóstico , Oftalmopatias Hereditárias , Gonioscopia , Humanos , Pressão Intraocular/efeitos dos fármacos , Masculino , Tomografia de Coerência Óptica , Acuidade VisualAssuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Betaxolol/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Transtornos da Visão/prevenção & controle , Antagonistas Adrenérgicos beta/administração & dosagem , Betaxolol/administração & dosagem , Humanos , Pressão Intraocular/efeitos dos fármacos , Pessoa de Meia-Idade , Soluções Oftálmicas , Transtornos da Visão/etiologiaRESUMO
PURPOSE: To investigate the progression rates of superior and inferior hemifield defects and each hemifield in bihemifield defects in normal-tension glaucoma patients and to compare the progression rates of each hemifield between groups in eyes with similar baseline hemifield defects. DESIGN: Retrospective, observational cohort study. METHODS: Medical records of 142 normal-tension glaucoma patients who performed more than 5 reliable standard visual field tests with superior (group 2; n = 51), inferior (group 1; n = 44), or both hemifield (group 3; n = 47) defects were analyzed retrospectively. The changes in the mean thresholds of the 10 zones of the glaucoma hemifield test and the entire hemifield were inspected. A linear mixed effect model was used with age, gender, initial intraocular pressure, mean deviation, and pattern standard deviation controlled. RESULTS: There were no significant differences in age and systemic and ocular factors between groups except for female gender, which showed a significant difference among the 3 groups (P = .032). The progression rate in group 2 was significantly faster than in group 1 (-0.713 dB/year vs -0.516 dB/year; P = .019), especially in central and nasal zones or than in the superior hemifield of group 3 (-0.717 dB/year vs -0.470 dB/year; P = .001). There was no significant difference in the progression rates between group 1 and the inferior hemifield in group 3 (-0.508 dB/year vs -0.441 dB/year; P = .312) or between the superior and inferior hemifields in group 3 (-0.468 dB/year vs -0.442 dB/year; P = .662). CONCLUSIONS: More careful examination and caution is required in the treatment of normal-tension glaucoma patients with superior hemifield defect.
Assuntos
Pressão Intraocular , Glaucoma de Baixa Tensão/diagnóstico , Fibras Nervosas/patologia , Células Ganglionares da Retina/patologia , Transtornos da Visão/diagnóstico , Campos Visuais , Anti-Hipertensivos/uso terapêutico , Betaxolol/uso terapêutico , Tartarato de Brimonidina , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Latanoprosta , Glaucoma de Baixa Tensão/tratamento farmacológico , Glaucoma de Baixa Tensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prostaglandinas F Sintéticas/uso terapêutico , Quinoxalinas/uso terapêutico , Estudos Retrospectivos , Tonometria Ocular , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/fisiopatologia , Testes de Campo VisualRESUMO
AIMS: To report the persistence of glaucoma medical therapy in a database of 1006 patients with ocular hypertension (OHT), normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) attending the Glaucoma Clinic at Glasgow Royal Infirmary, Glasgow, UK. METHOD: Analyses have been carried out using specially written queries to generate reports relating to initial treatment choice and persistence for individual drugs. Queries were investigated in the database time period from 16 February 1982 to 11 February 2009. When investigating drug persistence, the results from the database were split into two distinct time periods from 1997 to 2001 and from 2002 to 2009 to reflect the available treatment options used. RESULTS: The number of patients with each diagnosis was as follows: POAG 608; OHT 246; NTG 152. The Kaplan-Meier estimate for mean persistence from 1997 to 2001 (time to treatment discontinuation) of latanoprost was 58.8 ± 1.95 months, timolol was 41.8 ± 3.94 months, brimonidine was 24.1 ± 3.05 months, and betaxolol was 22.9 ± 2.04 months. The Kaplan-Meier estimate for mean persistence from 2002 to 2009 of latanoprost (time to treatment discontinuation) was 52.0 ± 2.26 months, bimatoprost was 25.8 ± 2.89 months, and travoprost was 23.0 ± 1.27 months. The Kaplan-Meier estimate for mean persistence of latanoprost (time to treatment change) was 37.5 ± 2.47 months, travoprost was 30.2 ± 2.70 months, and bimatoprost was 17.5 ± 2.88 months. CONCLUSION: The introduction of the first prostaglandin analogue, latanoprost, dramatically improved treatment persistence for glaucoma patients. In the current prostaglandin-rich treatment environment, these data do not show any significant differences between prostaglandins with respect to treatment persistence.
Assuntos
Anti-Hipertensivos/uso terapêutico , Betaxolol/uso terapêutico , Glaucoma/tratamento farmacológico , Hipertensão Ocular/tratamento farmacológico , Quinoxalinas/uso terapêutico , Timolol/uso terapêutico , Algoritmos , Tartarato de Brimonidina , Protocolos Clínicos , Bases de Dados Factuais , Uso de Medicamentos , Feminino , Glaucoma/epidemiologia , Humanos , Masculino , Hipertensão Ocular/epidemiologia , Escócia/epidemiologiaRESUMO
PURPOSE: To evaluate: (i) the relationship between intraocular pressure (IOP) reduction attained with a fixed treatment protocol and the untreated IOP level; (ii) the consistency of IOP reduction over time; and (iii) whether there is a threshold pretreatment IOP level below which IOP reduction might be less effective. Results are based on 128 patients with glaucoma with field defects, who were randomized to the treatment arm of the Early Manifest Glaucoma Trial (EMGT). METHODS: The EMGT fixed treatment protocol consisted of 360° laser trabeculoplasty and topical betaxolol eye drops B.I.D. Treatment was unchanged as long as progression did not occur. Analyses assessed the initial IOP reduction after 3 months and also the mean reduction based on all follow-up values; IOP changes over time were evaluated with linear regression analysis. Factors influencing initial and mean IOP reduction were also explored using linear models. RESULTS: Mean age at baseline was 68 years, and untreated baseline IOP ranged from 13 to 30.5 mmHg. On average, eyes with higher baseline IOP experienced larger pressure reductions than eyes with lower baseline IOP, whether expressed in mmHg or as percentages. Each mmHg of higher baseline IOP was associated with approximately 0.6 mmHg larger IOP reduction. IOP changed little over time, with 66% of patients changing less than 0.5 mmHg/year, and only 13% (17/128) changing >1.0 mmHg/year. The treatment protocol did not achieve any average IOP reduction in eyes with baseline pressures ≤ 15 mmHg. Factors related to more IOP reduction at 3 months were higher baseline IOP and positive refractive error, while higher baseline IOP and male gender (more reduction) and cardiovascular disease history (less reduction) were associated with mean IOP on treatment. CONCLUSION: With a fixed treatment protocol, the IOP reduction achieved depended very strongly on baseline untreated IOP levels. There seemed to be a lower threshold around 15 mmHg, where therapy did not result in any reduction of IOP. Our results suggest that when effects of IOP-lowering treatment are reported, whether expressed in mmHg or as a percentage of untreated pressure levels, the baseline IOP levels should be specified as well.
Assuntos
Anti-Hipertensivos/uso terapêutico , Betaxolol/uso terapêutico , Glaucoma de Ângulo Aberto/terapia , Pressão Intraocular/fisiologia , Trabeculectomia , Idoso , Terapia Combinada , Progressão da Doença , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Lasers de Gás , Masculino , Pessoa de Meia-Idade , Tonometria Ocular , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Campos Visuais/fisiologiaRESUMO
The use of beta-blockers is an important component of therapy of cardiovascular pathology (e.g. coronary heart disease, arterial hypertension) in menopausal women. Comparative data on the efficiency of lokren and carvedilol for the correction of grade 2 AH are presented.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Betaxolol/uso terapêutico , Carbazóis/uso terapêutico , Hipertensão/tratamento farmacológico , Propanolaminas/uso terapêutico , Antagonistas Adrenérgicos beta/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Betaxolol/efeitos adversos , Carbazóis/efeitos adversos , Carvedilol , Feminino , Humanos , Lipídeos/sangue , Pessoa de Meia-Idade , Pós-Menopausa , Propanolaminas/efeitos adversosAssuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Betaxolol/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Soluções Oftálmicas/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Betaxolol/uso terapêutico , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/patologia , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas/uso terapêutico , Testes do Emplastro , Timolol/efeitos adversos , Timolol/uso terapêuticoRESUMO
PURPOSE: To evaluate the influence of the extent of myopia on the progression rate of normal-tension glaucoma (NTG). DESIGN: Retrospective, observational case series. METHODS: One hundred forty-three eyes of 143 patients with NTG who were treated from 1994 through 2006 and followed up with standard automated perimetry were evaluated in this study. The participants were divided into 4 groups: mild myopia (-0.76 to -2.99 diopters [D]), moderate myopia (-3 to -5.99 D), severe myopia (-6 D or less), and nonmyopia (emmetropia and hyperopia, -0.75 D or more) groups. The change in mean deviation, corrected pattern standard deviation, mean thresholds of 10 zones corresponding to the glaucoma hemifield test, and thresholds of 52 points of the nonmyopia group were compared with those of the other myopia groups. Additionally, we controlled each analysis for age and posttherapeutic intraocular pressure to preclude the possibility of these covariates influencing the analysis of the effect of myopia on the progression of glaucoma. RESULTS: There was no statistically significant difference between the nonmyopia group and each of the myopia groups in terms of mean deviation, corrected pattern standard deviation, mean thresholds of 10 zones corresponding to the glaucoma hemifield test, and the thresholds of 52 point changes against refraction. Moreover, with the control of the other covariates (age and posttherapeutic intraocular pressure), no statistically significant differences were noted (multivariate analysis using mixed model, P > .1). CONCLUSIONS: Although a high incidence of open-angle glaucoma among myopic patients has been reported previously, myopia did not influence the progression rate of NTG after treatment.