Newly or switching effect of a selective EP2 agonist on intraocular pressure in Japanese patients with open-angle glaucoma.

PURPOSE: To evaluate omidenepag isopropyl (OMDI) for its efficacy in intraocular pressure control (IOP) and adverse reactions following administrations in Japanese patients with open-angle glaucoma (OAG) over a 3-month period. STUDY DESIGN: Retrospective observational study. SUBJECTS AND METHODS: Group 1 included untreated OAG patients, Group 2 included OAG patients treated with prostaglandin F (FP) receptor agonists (monotherapy) and Group 3 included OAG patients treated with multidrug therapy, including FP receptor agonists. OMDI was newly administered in Group 1, and FP receptor agonists were switched to OMDI in Group 2. In Group 3, all other ocular hypotensive medications were continued except FP receptor agonists. IOP changes were examined, and adverse reactions were retrieved from the medical records. RESULTS: Group 1 included 32 eyes, Group 2, 20 eyes and Group 3, 17 eyes. In Group 1, the baseline IOP was 15.7 mmHg (95% confidence interval [CI] 14.7-16.8 mmHg). After eyedrop treatment, the IOP was 14.1 mmHg (P < 0.001) at 1 month and 13.7 mmHg (P < 0.001) at 3 months. By contrast, in Group 2 and Group 3, switching FP receptor agonists to OMDI did not result in significant IOP changes (P ≥ 0.71). Six patients developed adverse reactions (hyperemia, headache, ocular pain, and swollen eyelids). CONCLUSIONS: New administration of OMDI significantly reduced the IOP. Furthermore, the IOP did not change after switching from FP receptor agonists to OMDI, including multidrug therapy. OMDI can be used as a first-line drug and is comparable to FP receptor agonists in Japanese patients with OAG.

Ocular manifestation in treated multibacillary Hansen's disease.

PURPOSE: To report the prevalence of ocular morbidity in patients with treated multibacillary Hansen's disease (HD) using modern ophthalmic diagnostic techniques in a rural community endemic for HD. DESIGN: Cross-sectional, observation study. PARTICIPANTS: All patients with multibacillary HD who had completed their multidrug therapy and who resided in 4 defined geographical areas in Vellore, Tamil Nadu, India. METHODS: All participants underwent a complete eye examination that included slit-lamp examination, esthesiometry, gonioscopy, applanation tonometry, and dilated fundus examination, including a stereobiomicroscopic examination of the fundus at an ophthalmic center set up for that purpose. Glaucoma suspects underwent automated perimetry using a Humphrey Field Analyzer (Humphrey Instruments, San Leandro, CA). MAIN OUTCOME MEASURES: The prevalence of various ocular disease parameters were reported as mean value with 95% confidence interval. The difference of disease prevalence between various leprosy groups was compared using an unpaired t test. The association between eye symptoms and potentially sight-threatening complications was analyzed using the chi-square test. RESULTS: Three hundred eighty-six of the 446 patients with multibacillary HD residing in the defined areas were evaluated. Four patients (1.04%; 95% confidence interval [CI], 0.0%-2.0%) were bilaterally blind; 33 (8.55%; 95% CI, 5.8%-11.3%) had unilateral blindness. Mean intraocular pressure was 12 mmHg (standard deviation, 4.1 mmHg), and prevalence of glaucoma was 3.6% (95% CI, 1.8%-5.5%). Potentially sight-threatening (PST) pathologic features (corneal anesthesia, lagophthalmos, uveitis, scleritis, and advanced glaucoma) were present in 10.4% (95% CI, 7.4%-13.4%) of patients. Significant cataracts occurred 3 times more frequently in those with polar lepromatous leprosy. The odds ratio for PST pathology in the presence of patient-reported symptoms (pain, redness, inability to close eye, burning, and irritation) was 2.9 (95% CI, 1.34-6.26). CONCLUSIONS: Patients who have completed treatment for multibacillary HD continue to have significant ocular morbidity. A history of specific eye symptoms can be the basis for referral by field staff.

Variation of intraocular pressure in patients with leprosy.

INTRODUCTION: There are various controversial reports on intraocular pressure (IOP) in patients with leprosy. PURPOSE: The current study was undertaken to study the level of intraocular pressure in leprosy patients and its association with the risk factors. MATERIALS AND METHODS: This was a prospective cross sectional comparative study. An ophthalmologist and a dermatologist evaluated consecutive 93 patients with leprosy. The risk factors studied were age, gender, bacillary index, clinical diagnosis, duration of disease and treatment; and ocular complications. The IOP in these patients was compared with healthy age and sex matched controls. RESULTS: A total of 186 leprosy patients (93) and healthy controls (93) were studied. The mean applanation IOP for the right and left eyes in leprosy patients was 12.87 1.20 mm of Hg and 13.222.70 mm of Hg respectively. This was found to be significantly lesser (p<0.001) than in the controls (RE=15.142.58 and LE=15.412.36 mmHg). The untreated leprosy patients had significantly lower IOP than those with treatment (p<0.001). None of the risk factors were found to be independently associated with the decrease in IOP. The duration of treatment, however, showed a trend towards having a significant association (p=0.057) with the lower level of IOP. CONCLUSION: The level of IOP is lower in leprosy patients than in the healthy controls. Age, gender, bacillary index and presence of ocular complications due to leprosy are not independently associated with the decrease in IOP. The untreated leprosy patient tends to have a lower IOP. This finding can be used to monitor effectiveness of treatment of leprosy.

[Ocular impairment in leprosy].

Leprosy causes several ocular disorders, and it also causes aftereffect with high frequency in various ways. Primary impairment is the ocular disturbance caused with direct invasion of nerve and ocular tissue by Mycobacterium leprae. Secondary impairment is the complication of nerve paralysis and residual inflammation due to primary disorder. Main work at Japanese national leprosariums has been the control of primary and secondary impairment in recent years. Clinical ophthalmic study in the leprosarium revealed a increase of age-related ocular disease in addition to aftereffect of leprosy. Severe sequelae due to sensory and functional disturbance will require suitable applications of advanced clinical technologies.

Estudo da variação da pressão intraocular em hansenianos / Variation of study intraocular pressure in leprosy patients

Objetivo: O objetivo da pesquisa foi estudar as variações da pressão intraocular (PIO) em hansenianos. Método: Neste estudo, foram submetidos a exame oftalmológico 575 hansenianos de controle ambulatorial, de ambos os sexos, com diferentes formas clínicas da doença, faixa etária variando de 4 a 89 anos (média 40,97), procedentes de 9 regiões de alta prevalência de lepra no Estado do Amazonas, Brasil. Resultados: O estudo apresentou associação significativa (p menor que 0,05) de PIO acima de 21mmHg com a presença de goniosinéquias e estado reacional da doença. Esses níveis elevados de PIO também estavam associados com a forma clínica LL e a presença de ângulo camerular estreito. Conclusões: A iridociclite é o principal fator que origina as alterações do seio camerular e que facilitaria as elevações da PIO. Esse dado sugere que hansenianos com PIO elevada têm maior susceptibilidade para glaucoma do que hipertensos oculares na população em geral.

Estudo da variação da pressão intra-ocular postural e do tempo do ciclo pupilar na hanseníase / ?

Com o objetivo de estudar a variação da pressão intra-ocular postural e o tempo do ciclo pupilar em hansenianos de controle ambulatorial de um hospital universitário, foram selecionados voluntários sadios e pacientes paucibacilares e multibacilares. As medidas da pressão intra-ocular, realizadas com a tonometria de aplanação, demonstraram que as pressões intra-oculares médias na posição sentada, não apresentaram diferenças estatisticamente significativas entre os grupos estudados. As medidas realizadas na posição sentada e em decúbito dorsal imediato demonstraram que houve tendência à maior variação da pressão intra-ocular postural no grupo multibacilar, não havendo, entretando, significância estatística no achado; as medidas realizadas cinco minutos após a permanência na posição de decúbito dorsal demonstraram aumento siginificativo da pressão intra-ocular no grupo multibacilar. As medidas do tempo do ciclo pupilar, realizadas clinicamante na lâmpada de fenda, apresentaram-se mais prolongadas no grupo multibacilar, seguidas pelo paucibacilar e pelo controle, havendo diferenças estatíticamente significativas entre este e o multibacilar. Os achados podem sugerir comprometimento do sistema nervoso autônomo ocular, mas não foi observada correlação entre a variação da pressão intra-ocular postural e o tempo do ciclo pupilar na hanseníase.

Alteraçöes posturais das pressöes intra-ocular e arterial em portadores da doença de Hansen / The postural changes on intraocular and blood pressure in patients with Hansen's disease

Os autores verificaram as pressöes intra-ocular e arterial de 40 pacientes com doença de Hansen que residem em colônia de hansenianos e 20 indivíduos voluntários sadios. Os pacientes e o grupo controle tiveram as pressöes intra-ocular e arterial verificadas 6 vezes. As pressöes intra-ocular e arterial foram tomadas após os pacientes deitarem em decúbito dorsal e todo o procedimento foi repetido 5 e 10 minutos após deitarem. Foi pedido aos pacientes para sentarem e novas medidas foram tomadas, isto é, imediatamente, 5 e 10 minutos após sentarem. A média de Po foi significantemente maior na posiçäo deitada do que sentada, para todos os tempos estudados, em ambos os grupos (p<0,001). Näo foi encontrada diferença significante entre indivíduos normais e portadores da Doença de Hansen. Também näo foi encontrada alteraçäo da pressäo arterial nas diferentes posiçöes estudadas em ambos os grupos

Intraocular pressure in leprosy patients without clinically apparent anterior segment pathology.

A widely prevalent notion is that intraocular pressures are generally lower in leprosy patients than in normal individuals. Applanation intraocular pressures were recorded in one hundred sixty-six leprosy patients who had no clinically visible anterior segment pathology and in one hundred and eleven healthy controls. Mean (SD) intraocular pressures in leprosy patients (13.6 (3.0) mm Hg) did not differ significantly from that of controls (13.1 (2.7) mm Hg). Eyes of only 1.5% of the leprosy patients had pressures of 7 mm Hg or less. Correlation coefficients (r) between age, sex and intraocular pressures were not statistically significant both in leprosy patients and in controls. No statistically significant differences in mean intraocular pressures were noted when leprosy patients were grouped according to the Ridley and Jopling classification. Duration of disease also did not affect the intraocular pressures. Neither did smear positivity or differing bacterial indices. This study questions the widely held belief that low intraocular pressures are a common feature in leprosy and contends that in the era of MDT where ocular complications associated with low intraocular pressures are thought to be less, the occurrence of low intraocular pressure may not be as common a phenomenon as it is believed to be.

Ocular manifestations of Hansen's disease.

A detailed ophthalmic evaluation including slitlamp biomicroscopy, measurement of corneal sensitivity using Cochet and Bonnet aesthesiometer, Schirmer's test and Goldmann applanation tonometry was carried out in 89 patients of Hansen's disease attending the leprosy clinic with or without ocular symptoms and willing to undergo eye evaluation. Thirty-one patients had lepromatous leprosy (8 with erythema nodosum leprosum), 56 patients had borderline disease (13 with reversal reactions) and 2 had tuberculoid disease. In addition to the well documented changes of lagophthalmos (6.7%), uveitis (7.3%) and cataracts (19%), we noted prominent corneal nerves in 133 eyes (74.7%), beaded corneal nerves in 19 eyes (10.7%), corneal scarring in 10 eyes (5.6%), corneal hypoaesthesia in 51 eyes (28%) and dry eye in 18 eyes (13%). Beaded corneal nerves and/or stomal infiltrates occurred mainly in the lepromatous group (75%). Ocular hypotony (IOP less than 12 mm Hg) was not seen more frequently in Hansen's as compared to age and sex matched controls with refractive errors or cataracts (33.7%, vs. 37.8%, p = 0.33). Our study highlights the primary corneal involvement with corneal neuropathy as the predominant feature of Hansen's disease.

Intraocular pressure decrease in household contacts of patients with Hansen's disease and endemic control subjects.

We compared the intraocular pressure in 150 urban household contacts of patients with Hansen's disease and 132 endemic control subjects from an urban population in Karachi, Pakistan, who were matched in regard to race, age, gender, and socioeconomic status. The mean intraocular pressure in the upright position was 12.6 mm Hg in the right eye and 12.9 mm Hg in the left eye in household contacts of patients with Hansen's disease and 15.3 mm Hg in the right eye and 15.4 mm Hg in the left eye in the endemic control population (P < .0005). The postural change in intraocular pressure from the upright to supine position was 1.7 mm Hg in the right eye and 2.1 mm Hg in the left eye in the household contacts group and 1.3 mm Hg in the right eye and 1.5 mm Hg in the left eye in the endemic control group (P < .0006). Our findings, especially in view of past observations in intraocular pressure changes in patients with Hansen's disease, raise serious questions about possible early ocular susceptibility to Mycobacterium leprae infection and about public health issues, including possible early indication of disease.

Influence of untreated chronic plastic iridocyclitis on intraocular pressure in leprosy patients.

The intraocular pressures of a total of 286 eyes of patients with lepromatous and borderline lepromatous leprosy who never had regular ophthalmological care or local eye treatment were measured. The patients were categorised according to the type of leprosy they had, and the eyes were categorised as without or with chronic plastic iridocyclitis. In patients with lepromatous and borderline lepromatous types of leprosy the intraocular pressure was significantly lower in eyes with chronic plastic iridocylitis 10.1 (3.6) mmHg than in both unaffected eyes 11.0 (3.2) mmHg and control eyes 13.5 (2.5) mmHg. It has been shown that chronic plastic iridocyclitis which remains untreated for years results in a lower intraocular pressure than normal.

Intraocular pressure changes and postural changes of intraocular pressure in experimentally induced Hansen's disease of rhesus, mangabey, and African green monkeys.

In our long term evaluation of patients with Hansen's disease we have frequently found reduction of their intraocular pressure. Furthermore, we noted changes in their intraocular pressure on change of posture. To determine if these changes have any significance we measured the intraocular pressures of 24 experimentally infected and 39 control monkeys in both sitting and reclining positions. We found significant reduction of intraocular pressure in 66.7% compared with controls in the sitting position, and a significant increase in intraocular pressure in 79% when checked first in the sitting then in the reclining position. We offer a possible pathophysiological explanation as to why the changes occur.

Intraocular pressure and iris denervation in Hansen's disease.

We retrospectively analyzed 255 Hansen's disease patients and found low intraocular pressure (less than 7 mm Hg) in 12% of them. We showed a correlation between low intraocular pressure and avascular keratitis and iritis. We also found that patients with low intraocular pressures had abnormally large postural changes in intraocular pressure. We speculate that abnormalities in the autonomic innervation of the anterior segment of the eye may be related to the intraocular pressure abnormalities. Further investigations along this line may increase our understanding not only of the pathophysiology of Hansen's disease but also of the mechanisms regulating homeostasis of intraocular pressure.

Low intraocular pressure and postural changes in intraocular pressure in patients with Hansen's disease.

We found intraocular pressures of less than 7 mm Hg in 11 of 72 patients (15%) with early Hansen's disease. Furthermore, significant postural changes in intraocular pressure (greater than 30%) occurred in 43 of 72 patients (60%). This loss of intraocular pressure homeostasis, which results from reduced aqueous humor production or increased uveoscleral outflow with reduced local adrenergic control in the ciliary body-iris-trabecular meshwork region, suggests that early autonomic neuropathy of the eye may occur in Hansen's disease. The only predictive value for significant postural change in intraocular pressure was the presence of immunologically unstable disease.

Ocular leprosy: a case report and discussion of the pathology.

Although leprosy is considered rare in Australia outside the Northern Aboriginal population, its presence within Indian and Southeast Asian migrant groups must be considered. A case of ocular leprosy is presented in which the definitive diagnosis was delayed because lid changes had been diagnosed as senile ectropion. The pathology of ocular leprosy is discussed, together with relevant therapeutic considerations.