Intracameral tissue plasminogen activator in trabeculectomy: a 1-year prospective, randomized, controlled study.

PURPOSE: To evaluate the safety and the adjunctive effect of intracameral tissue plasminogen activator (tPA) in trabeculectomy for patients with primary open-angle glaucoma (POAG). METHODS: This was a prospective, randomized study consisting of patients with POAG who underwent trabeculectomy in Tel Aviv Medical Center between March 2013 and December 2014. Patients were randomly assigned to two groups: Group 1 underwent mitomycin C (MMC) trabeculectomy and group 2 underwent MMC trabeculectomy with intracameral tPA. Complete and overall success were defined as intraocular pressure (IOP) between 5 and 18 mmHg and at least 30% IOP drop without and with or without anti-glaucoma treatment, respectively. RESULTS: A total of 16 patients (seven females and nine males) were recruited, and eight patients were assigned to each group. IOP at presentation was 27 ± 5.3 mmHg and 25.3 ± 5.1 mmHg, compared to 13.7 ± 4.3 mmHg and 10.6 ± 2.0 at 12 months (p < 0.0001) for groups 1 and 2, respectively. Complete success at 12 months was achieved in 62.5% of group 1 compared to 87.5% of group 2 (p = 0.28). Overall success was achieved in 87% compared to 100% of patients at 12 months (p = 0.33). No evidence of complications attributable to tPA was found. CONCLUSIONS: Augmentation of tPA during MMC trabeculectomy may have better complete and overall success rates, compared to MMC trabeculectomy. The safety profile was similar for both groups.

Original and generic latanoprost for the treatment of glaucoma and ocular hypertension: are they really the same?

We compared the intraocular pressure (IOP)-lowering effect and safety profile of latanoprost (Xalatan) with its generic variant, Glautan (Unipharm, Tel Aviv, Israel). After 1 and 4 weeks of treatment, a randomized, prospective, cross-over comparison was carried out that included patients with open-angle glaucoma or ocular hypertension, either naïve or treated and well-controlled, who were attending the Department of Ophthalmology, Tel Aviv Medical Centre, Tel Aviv, Israel, between May 2010 and November 2012. After a 3-week washout period for the medicated subjects, the participants were randomized to 4 weeks of treatment with either Xalatan or Glautan once every evening and then, after a 3-week washout period, crossed-over to the other treatment for an additional 4 weeks. Efficacy was expressed by a change in intraocular pressure at three designated hours of the day after 1 week and 1 month of treatment, and tolerability was determined by ocular side-effects as reported by the patient in a questionnaire. A total of 19 patients (mean age at initial diagnosis 66 ± 9 years, 14 females) were enrolled, of whom 17 had bilateral open-angle glaucoma and two had unilateral disease. Both drugs lowered intraocular pressure after 1 week and 1 month (P = 0.06 and P = 0.04, respectively) of treatment. Xalatan had a tendency of greater efficacy than Glautan both after 1 week and 1 month, but the difference was not statistically significant (P = 0.69 and P = 0.34, respectively). Drug safety was similar for Xalatan or Glautan, but more ocular side-effects were reported after treatment with Glautan (21 vs 12 for Xalatan, P = 0.06).

Evaluation of the retinal, choroidal, and nerve fiber layer thickness changes in patients with toxic anterior segment syndrome.

PURPOSE: To evaluate changes in choroidal, retinal, and nerve fiber layer (NFL) thickness following toxic anterior segment syndrome (TASS). METHODS: Macular and peripapillary choroidal thickness was measured using enhanced depth imaging (EDI) optical coherence tomography (OCT) on the day of the diagnosis and on three follow-up exams (months 1 to 4). A similar OCT analysis of central retinal and NFL thickness was performed. RESULTS: Thirteen TASS patients were included. Average age was 72.8 ± 8.7 years. Macular choroidal thickness in the superior, subfoveal, and nasal macula in the study eye was larger than the control eye and decreased at months 2-4. This was statistically significant only for the superior macula (p = 0.004). Peripapillary choroidal thickness was larger in the study eye at baseline compared with the control eye-significantly so in the nasal (p = 0.026) and inferior (p = 0.033) locations. Peripapillary choroidal thickness peaked at the baseline or 1st month exam and decreased thereafter. Retinal thickness increased significantly with time, peaking at the 2nd month and decreasing thereafter. No changes were found in the NFL. CONCLUSIONS: TASS may have a transient effect on the choroid. Changes in retinal thickness are probably a normal transient postoperative response and not a result of TASS.

Topical bevacizumab for neovascular glaucoma: a pilot study.

BACKGROUND/AIMS: Bevacizumab (Avastin), an anti-vascular endothelial growth factor drug, has been successfully used in recent years to treat ocular pathologies, mostly by intravitreal administration. The aim of this study was to investigate the safety and efficacy of topically applied bevacizumab for the treatment of neovascular glaucoma (NVG). METHODS: Patients with NVG were treated with topical bevacizumab (25 mg/ml) 4 times daily during 2 weeks. The following parameters were evaluated at baseline and on days 3, 7 and 14: visual acuity, slit-lamp examination, intraocular pressure (IOP), heart rate and systemic blood pressure. Iris neovascularization was documented using slit-lamp color photos at baseline and on day 14. RESULTS: Eight eyes of 8 patients with NVG were evaluated. After the 2-week treatment, mean IOP was lowered from 34.9 mm Hg (SD 12.8) at baseline to 28.8 mm Hg (SD 9.9) on day 14, representing a mean reduction of 6.1 mm Hg (17.5%). Three patients had clinical regression of their iris neovascularization. Ocular adverse events were transient and included mild upper eyelid swelling, mild exacerbation of superficial punctate keratitis and mild corneal epithelial bullae in an already edematous cornea. There were no serious systemic adverse events. CONCLUSIONS: Topical application of bevacizumab may lower IOP and result in regression of neovascularization in patients with NVG.

[Comparison of dynamic contour tonometry, Goldmann applanation Tonometry and tonopen for measuring intraocular pressure in normal tension glaucoma].

BACKGROUND: Normal tension glaucoma (NTG) is a chronic progressive optic neuropathy, characterized by relatively normal intraocular pressure (IOP) measurements. This study utilized three modalities in the measurement of lOP: dynamic contour tonometry (Pascal-DCT), Goldmann applanation tonometry (GAT) and Tonopen XL. OBJECTIVES: To compare the lOP measurements of the three devices in eyes with NTG. METHODS: This retrospective study of thirty-three NTG patients (66 eyes) who underwent lOP measurements using the three devices was approved by a local ethics committee. The lOP measurements were stratified according to central corneal thickness (CCT) and corneal curvature (CC). RESULTS: The mean DCT IOP was higher (16.22 +/- 3.04 mmHg) than the mean GAT IOP (13.14 +/- 2.83 mmHg, P < 0.0042). The mean Tonopen XL lOP was lower than the mean GAT IOP (12.76 +/- 3.11 mmHg, P < 0.001). GAT and DCT measurements were significantly infLuenced by corneal curvature (P = 0.004 and P < 0.0001, respectiveLy). CONCLUSIONS: lOPs measured by GAT or Tonopen XL were consistently lower than by DCT. CC significantly influenced GAT and DCT results.

Intracameral bevacizumab role in trabeculectomy: A 1-year prospective randomized controlled study.

PURPOSE: To evaluate the effect of intracameral Bevacizumab on trabeculectomy success rates. METHODS: A prospective, randomized, interventional clinical trial. Patients with primary open-angle glaucoma were randomly assigned to two groups: trabeculectomy with mitomycin C and trabeculectomy with mitomycin C and intracameral bevacizumab. Complete success is defined as an intraocular pressure (IOP) reduction of at least 30% from baseline IOP to a measured pressure of between 5 and 18 mm Hg without the use of IOP lowering medications. Qualified success is defined as same achievement of reduced IOP, but with the use of IOP lowering medications. Overall success is defined as same achievement of reduced IOP with or without the use of IOP lowering medications. RESULTS: Thirty-three patients in the mitomycin C group and 36 patients in the mitomycin C and bevacizumab group were included in final analyses. The IOP at presentation was 28.3 ± 8 and 28.4 ± 8.6 mm Hg, compared to 10.8 ± 3.4 and 12.3 ± 3.7 mm Hg at 12 months (p < 0.0001) for the mitomycin C group and the mitomycin C and bevacizumab group, respectively. Complete success at 12 months was achieved in 65% of the mitomycin C group compared to 60% of the mitomycin C and bevacizumab group (p = 0.77). Overall success was achieved in 82% compared to 80% of patients at 12 months (p = 0.78). Both groups showed a statistically significant reduction in IOP after 6 and 12 months (p ⩽ 0.001). There were no statistically significant differences in visual acuity and complications. CONCLUSION: Intracameral bevacizumab during mitomycin C trabeculectomy in patients with primary open-angle glaucoma apparently does not improve success rates. The adjuvant use of intracameral bevacizumab is therefore not justified.

Effect of brimonidine tartrate on basophil activation in glaucoma patients.

AIM: To evaluate the mechanism of which brimonidine tartrate 0.15% causes clinical hypersensitivity. METHODS: A prospective case-control study comparing 8 glaucoma patients with clinical hypersensitivity to brimonidine to a control group consisting 13 healthy volunteers. Blood samples were stimulated with brimonidine 0.15%, timolol 0.5% or brimonidine tartrate/timolol maleate 0.2%/0.5%. Premixed antibodies (CD63/FITC and aIgE/PE) were added for direct staining and whole-blood samples were lysed, fixed and analyzed by a flow cytometer. The basophil population was defined by high IgE cell expression. Degranulation was identified by the expression of the activation molecule CD63. RESULTS: Basophil activation was not significant when comparing percent of activated basophils of patients and healthy controls after exposure to brimonidine (2.58%, 2.45%, respectively, P=0.72). There was a significant suppression of basophil activation when a combination of brimonidine-timolol (0.87%) was compared to timolol (2.27%; P=0.012) and to brimonidine alone (2.58%; P=0.017). CONCLUSION: The results of our study do not support the hypothesis that brimonidine induces an immediate allergic reaction. Basophil activation was suppressed by the presence of ß-blockers in patients hypersensitive to brimonidine and in healthy individuals. This finding indicates that timolol suppress brimonidine drug reaction by a different mechanism.

Pressure phosphene tonometry versus Goldmann applanation tonometry for measuring intraocular pressure before and after LASIK.

PURPOSE: To compare pressure phosphene tonometry with Goldmann applanation tonometry for measuring intraocular pressure (IOP) before and after LASIK. METHODS: Forty-three (18 men and 25 women) consecutive healthy patients underwent complete pre- and postoperative LASIK ophthalmologic assessments including manifest and cycloplegic refraction, keratometry, and central corneal thickness. Three repetitive sets of pressure phosphene tonometry and Goldmann applanation tonometry measurements were performed the day before and 3 months following uneventful LASIK. RESULTS: Mean preoperative spherical equivalent refraction was -4.70 +/- 2.50 diopters (D) (range: -1.50 to -12.90 D) and mean preoperative keratometry was 43.95 +/- 1.08 D. After LASIK, spherical equivalent refraction was +0.23 +/- 0.11 D and mean keratometry was 39.46 +/- 2.28 D. Preoperative pressure phosphene tonometry (12.16 +/- 1.58 mmHg) and Goldmann applanation tonometry (12.01 +/- 1.55 mmHg) IOP measurements were similar. Postoperative IOP was 10.30 +/- 1.16 mmHg with Goldmann applanation tonometry and 12.20 +/- 1.62 mmHg with pressure phosphene tonometry. The postoperative IOP difference between Goldmann applanation tonometry and pressure phosphene tonometry was 0.15 +/- 1.12 mmHg (P = .41). The mean change in pachymetry after LASIK was 68.73 +/- 73 microm. The change in Goldmann applanation between preoperative and postoperative LASIK values was 1.71 +/- 1.43 mmHg (P < .0001), a change that was strongly correlated with changes in corneal thickness (R = 0.75, P < .0001) and keratometry (R = 0.72, P < .0001). No such correlations were found with pressure phosphene tonometry. CONCLUSIONS: Goldmann applanation tonometry-measured IOP decrease after LASIK is strongly correlated with a decrease in central corneal thickness and changes in keratometry, whereas pressure phosphene tonometry-measured IOP is independent of corneal thickness. Pressure phosphene tonometry appears to be a more reliable method for recording tonometry in these patients.

Comparison of intraocular pressure measurements using Goldmann tonometer, I-care pro, Tonopen XL, and Schiotz tonometer in patients after Descemet stripping endothelial keratoplasty.

PURPOSE: Post-Descemet stripping endothelial keratoplasty (DSEK) patients are prone for intraocular pressure (IOP) elevations and glaucoma. Corneal characteristics influence various IOP measuring devices in various ways. The aim of this study was to evaluate the agreement between four different IOP measuring devices: Goldmann applanation tonometer (GAT), I-care pro, Tonopen XL, and Schiotz tonometr in patients who underwent DSEK. METHODS: This was a prospective comparative study using a convenience cohort of post-DSEK patients with compact grafts. Post-DSEK patients had IOP measured using GAT, I-care Pro, Tonopen XL, and Schiotz tonometer. Measurements were compared and agreement assessed. Wilcoxon signed-rank test was used for comparison of means as variables did not show a normal distribution. Bland-Altman plots were used for assessing agreement. RESULTS: Thirty eyes of 24 patients were included in the study. Mean time from DSEK surgery was 25.31 ± 13.05 months. Mean IOP with GAT, I-care pro, Tonopen XL, and Schiotz tonometer was 13.99 ± 3.76, 13.92 ± 3.36, 13.31 ± 3.89, and 12.83 ± 4.07, respectively. GAT, I-care pro, and Tonopen XL had similar mean IOP measurements (P = 0.135 and P = 0.551, respectively), while Schiotz tonometry measurements were higher (P = 0.046). Bland-Altman plots show good agreement between GAT, Tonopen XL, and I-care pro. GAT and Schiotz tonometry show less agreement, with large variations in the differences of measured IOP. CONCLUSIONS: IOP measurements in post-DSEK patients showed good agreement between GAT and either Tonopen XL or I-care pro. Schiotz tonometer has large variations in this patient group. IOP measurements and IOP difference between devices were not dependent on central corneal thickness.

Trabeculectomy with Ex-PRESS implant versus Ahmed glaucoma valve implantation-a comparative study.

AIM: To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve (AGV) implantation. METHODS: Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review. Main outcome measures were surgical failure and complications. Failure was defined as intraocular pressure (IOP) >21 mm Hg or <5 mm Hg on two consecutive visits after 3mo, reoperation for glaucoma, or loss of light perception. Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy. RESULTS: A total of 64 eyes from 57 patients were included: 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group. The mean follow-up time was 2.6±1.1y and 3.3±1.6y, respectively. Patients in the AGV group had significantly higher baseline mean IOP (P=0.005), lower baseline mean visual acuity (VA) (P=0.02), and higher proportion of patients with history of previous trabeculectomy (P<0.0001). Crude failure rates were 16.1%, n=5/31 in the Ex-PRESS group and 24.2%, n=8/33 in the AGV group. The cumulative proportion of failure was similar between the groups, P=0.696. The proportion of eyes that experienced postoperative complications was 32.3% in the Ex-PRESS group and 60.1% in the AGV group (P=0.0229). CONCLUSION: Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates. The AGV group had more post-operative complications, but also included more complex cases with higher baseline mean IOP, worse baseline mean VA, and more previous glaucoma surgeries. Therefore, the results are limited to the cohort included in this study.

C-reactive protein levels in normal tension glaucoma.

PURPOSE: To determine C-reactive protein (CRP) levels in patients with normal tension glaucoma (NTG). METHODS: This study included 20 cases with NTG and 30 controls, with no history of ocular disease. Plasma CRP levels of all the study participants were determined using a highly sensitive CRP kit. RESULTS: Twenty cases (11 males, 9 females, mean age 69 +/- 5 years) with NTG and 30 age-matched controls (15 males, 15 females, mean age 68 +/- 6) were evaluated. Both groups had similar demographic parameters (age, sex, BMI). Plasma CRP levels were significantly higher in the NTG cases than in controls (median [range], 3.20 [0.17-8.4] mg/dL compared with 0.5 [0.1-3.2], P < 0.001). The mean plasma CRP level was significantly elevated in the NTG cases compared with the controls (3.21 +/- 0.6 mg/dL and 0.85 +/- 0.17 mg/dL, respectively, P < 0 0.01). CONCLUSION: Our findings suggest that higher CRP levels may be associated with NTG. It is possible that a vascular inflammatory process is involved in the etiology of this glaucoma.

From Georgia to Jerusalem: some Medical Aspects of "The Knight in the Panther's Skin" by Shota Rustaveli.

The Georgian poet Rustaveli wrote his epic poem The Knight in the Panther's Skin around 1200. He knew the works of Hippocrates and Galen, and believed in the unity of body and soul.Thereare many references to health and medicine in the poem, and we shall highlight some of them. In 1185 Rustaveli left Georgia and settled in Jerusalem. There he lived and died at the Monastery of the Cross, where he was buried.

Standard Trabeculectomy and Ex-PRESS Miniature Glaucoma Shunt: A Comparative Study and Literature Review.

PURPOSE: The aim of this study was to compare the efficacy and safety between standard trabeculectomy and the Ex-PRESS shunt implantation. METHODS: A retrospective review of the records of 100 eyes of 100 patients who underwent trabeculectomy or Ex-PRESS shunt implantation between July 2010 and June 2012 was conducted. Of these, 61 (61%) eyes underwent trabeculectomy and 39 (39%) eyes underwent Ex-PRESS shunt implantation. Demographic information, glaucoma type, surgical details, preoperative, and postoperative data including intraocular pressure (IOP), number of medications, reoperation, and occurrence of any complications were recorded. RESULTS: No differences in IOP reduction or number of postoperative IOP-lowering medications were demonstrated between the 2 procedures. Success rates were 86.9% for trabeculectomy and 84.6% for Ex-PRESS shunt. Rates of failure and hypotony were not significantly different between the groups. No parameter was correlated with success or failure of any procedure. CONCLUSIONS: Standard trabeculectomy and Ex-PRESS shunt have similar efficacy and safety profiles. As the Ex-PRESS shunt is considerably more expensive, its use may be unjustified, especially as a primary procedure.

Comparison of corneal flap thickness between primary and fellow eyes using three microkeratomes.

PURPOSE: To compare corneal flap thickness created in laser in situ keratomileusis (LASIK) in primary (right) and fellow (left) eyes (same blade for both eyes) using three microkeratomes. METHODS: The corneal thickness of 132 eyes (66 patients) was measured preoperatively and intraoperatively after flap creation. Corneal flap thickness was calculated by subtracting stromal bed thickness from total corneal thickness. Three microkeratomes were used: Nidek MK-2000, Bausch and Lomb Surgical Hansatome, and the Chiron Automated Corneal Shaper (ACS). Each patient had both corneas cut by one microkeratome and one blade at the same session. RESULTS: Mean corneal flap thickness created in primary eyes was 128.30 +/- 12.57 microm (range 105 to 147 microm) for the ACS (160-microm plate and 8.5-mm ring) and 122.96 +/- 13.30 microm (range 86 to 140 microm) for fellow eyes; Hansatome (160-microm plate and 8.5-mm ring): 141.16 +/- 20.11 microm (range 101 to 169 microm) in primary eyes and 120.95 +/- 26.95 microm (range 107 to 151 microm) in fellow eyes; Nidek (130-microm plate and 8.5-mm ring): 127.25 +/- 4.12 microm (range 116 to 134 microm) in primary eyes and 127.54 +/- 3.7 microm (range 119 to 134 microm) in fellow eyes. The corneal flap in the ACS and Hansatome microkeratomes was always thicker in the primary than the fellow eye, using the same blade for both eyes. No significant difference was found using the Nidek microkeratome. CONCLUSION: Corneal flap thickness tended to be thinner in fellow eyes than in primary eyes for the ACS and Hanstome microkeratomes. The Nidek microkeratome results were closer to specified corneal flap thickness than the ACS and Hanstome microkeratomes.

Predictability of corneal flap thickness in laser in situ keratomileusis using three different microkeratomes.

PURPOSE: To compare the accuracy and consistency of corneal flap thickness in the right and left eye created by three different widely used microkeratomes during consecutive laser in situ keratomileusis (LASIK). METHODS: Corneal thickness of 132 eyes of 66 patients was measured preoperatively and intraoperatively. Corneal flap thickness was calculated by subtracting the corneal stromal thickness from the total corneal thickness. Three different microkeratomes were used for creating the corneal flap: Chiron Automated Corneal Shaper (ACS), Baush and Lomb Surgical Hansatome, and Nidek MK 2000 microkeratomes. The same surgeon performed all procedures on the right eye first and then on the left eye using the same blade and the same surgical technique. RESULTS: Mean corneal flap thickness created by the ACS (160-microm depth setting) microkeratome was 128.30 +/- 12.57 microm in the right eye and 122.96 +/- 13.30 microm in the left eye. The Hansatome (160-microm depth plate) microkeratome created a flap of mean 141.16 +/- 20.11 microm in the right eye and 120.95 +/- 26.95 microm in the left eye, and the Nidek MK 2000 (130-microm depth plate) microkeratome created a flap of 127.25 +/- 4.12 microm in the right eye and 127.54 +/- 3.7 microm in the left eye. CONCLUSION: Corneal flap thickness tended to be considerably thinner than expected on both eyes using the ACS and Hansatome. With the ACS and Hansatome, the difference in corneal flap thickness between the first and second operated eye was statistically significant. With the Nidek MK 2000 microkeratome, there was no statistically significant difference between the first and second operated eye and measurements were close to desired corneal flap thickness. Intraoperative pachymetry is recommended for every LASIK procedure.

Effect of brimonidine tartrate 0.2% ophthalmic solution on pupil size.

PURPOSE: To evaluate the effect of brimonidine tartrate 0.2% ophthalmic solution on pupil size under scotopic and photopic luminance conditions in persons considering laser refractive surgery. SETTING: Ophthalmic Health Center, Tel Aviv, Israel. METHODS: The pupil size was measured in 36 eyes of 36 participants under scotopic and photopic conditions using the Colvard pupillometer (Oasis Medical) before and after brimonidine tartrate drops were administered. The pupil size was subsequently measured after 30 minutes and 4 and 6 hours. RESULTS: No difference was found in pupil size before brimonidine tartrate instillation in eyes with light or dark irides. Before instillation, the mean photopic pupil size was 4.81 mm +/- 0.54 (SD) (range 4.0 to 6.0 mm). At 30 minutes, all pupils became miotic, with a mean size of 3.77 +/- 0.51 mm (range 3.0 to 5.0 mm) (P<.0001). After 6 hours, 27.8% of the pupils had returned to their previous size. Before brimonidine tartrate administration, the mean scotopic pupil size was 6.22 +/- 0.73 mm (range 5.0 to 8.0 mm). There was significant miosis to 4.57 +/- 0.84 mm (range 3.0 to 6.5 mm) (P<.0001) that continued for at least 6 hours. The miotic effect of brimonidine tartrate was stronger in eyes with light irides. CONCLUSIONS: Brimonidine tartrate caused significant miosis, especially under scotopic conditions, most likely from its alpha-2 adrenergic effect. Under photopic luminance conditions, the miotic effect was pronounced.

The effect of latanoprost on accommodation in young patients with ocular hypertension.

PURPOSE: To determine whether topical latanoprost 0.005% had an effect on accommodative capacity after 1 month of treatment in young patients with ocular hypertension. PATIENTS AND METHODS: Fifteen patients (9 men and 6 women, aged 20-40 years) with ocular hypertension were instructed to instill the drug to their right eye for 1 month; the left eye received no medication and served as control. Near point of accommodation, refraction, and intraocular pressure (IOP) were determined after 1 month of treatment. RESULTS: After 1 month of treatment with latanoprost, the mean IOP was reduced by 22.8% (5.8 mm Hg) in the treated eye and 1.86% (0.47 mm Hg) in the untreated control eye. No significant changes in refraction or near point of accommodation were observed in the treated or untreated eye. CONCLUSION: Short-term treatment with latanoprost 0.005% does not effect refraction or accommodation in young patients with ocular hypertension.

Hyperhomocystinemia in pseudoexfoliation glaucoma.

PURPOSE: To determine the prevalence of hyperhomocystinemia in patients with pseudoexfoliation glaucoma. PATIENTS AND METHODS: This prospective study included 30 patients with glaucoma and 30 age-matched controls with no history of ocular disease who were undergoing routine physical checkups. Plasma homocysteine levels of all the study participants were determined using high-performance liquid chromatography, and values exceeding 15 micromol/L were considered elevated. RESULTS: The mean plasma homocysteine level was 16.80 +/- 3.20 and 12.39 +/- 1.97 micromol/L in glaucoma patients and controls, respectively (P<0.0001). Fifteen glaucoma patients (50%) had hyperhomocystinemia compared with 3 controls (10%) (P=0.0015). CONCLUSION: Hyperhomocystinemia may be associated with pseudoexfoliation glaucoma, which may partially explain the increased risk of vascular diseases among patients with pseudoexfoliation syndrome.

The efficacy and safety of once-daily versus once-weekly latanoprost treatment for increased intraocular pressure.

We evaluated the efficacy and safety of latanoprost eye drops once-weekly, compared to once-daily for improving patient compliance. Twenty (20) patients (11 women and 9 men), 12 with ocular hypertension and 8 with early glaucoma, were studied after washout of the antiglaucoma treatment. One (1) group was treated with latanoprost once-daily (control). The other group was treated once-weekly (study group). Intraocular pressure (IOP) was measured at baseline and on the 2nd, 4th, 6th, and 9th day after the last drop in the study group, and for 3 months on the same schedule thereafter. The mean baseline IOP was 24.3 +/- 3.9 mmHg in the study group (range, 18-29) and 24.4 +/- 4.4 mmHg in the control group (range, 17-32). The average IOP at all time points of post-treatment was 17.7 +/- 1.5 mmHg (range, 14-23) and 16.9 +/- 2.30 mmHg (range, 13-21), respectively. Latanoprost significantly lowered IOP in both groups (study group, p = 0.005; controls, p = 0.0019). The difference between post-treatment IOP was insignificant in both groups at each time point. The study group had fewer minor side effects than the control group (1/10 versus 6/10, respectively). Latanoprost treatment once-weekly was as effective, and bore fewer minor side effects, as once-daily treatment after 3 months of follow-up.