Experience with netarsudil 0.02% and latanoprostene bunod 0.024% as adjunctive therapy for glaucoma.

PURPOSE: To assess the effectiveness and safety of adjunctive topical netarsudil 0.02% and latanoprostene bunod 0.024% in patients with glaucoma. METHODS: A retrospective, multi-center, cohort study of patients with glaucoma treated with netarsudil 0.02% or latanoprostene bunod from five tertiary care centers. Inclusion criteria included patients with glaucoma treated with either medication as adjunctive therapy. Outcomes included mean absolute intraocular pressure (IOP) reduction and relative IOP reduction from baseline. Adverse reactions and reasons for discontinuation were reported. One-way analysis of variance, Kruskal-Wallis rank sum test, and Mann Whitney U test compared the outcomes. RESULTS: A total of 95 eyes (95 patients) on netarsudil and 41 eyes (41 patients) on latanoprostene bunod were analyzed. Mean duration of use was 54.3 ± 28 days for netarsudil and 82.9 ± 51.2 days for latanoprostene bunod. At the final visit, mean IOP reduction was 3.9 ± 4.6 mmHg (17.5 ± 6.0%) (p < 0.0001) with netarsudil and 2.9 ± 3.7 mmHg (13.6 ± 16.3%) (p < 0.0001) with latanoprostene bunod. IOP lowering did not depend on baseline number of IOP-lowering medications. The most common reason for discontinuation was non-effectiveness in both groups. CONCLUSION: Similar to monotherapy, netarsudil and latanoprostene bunod demonstrated efficacy in lowering IOP when used as adjunctive therapy.

Predicted refraction versus refraction outcome in cataract surgery after trabeculectomy.

PURPOSE: To determine whether the manifest refraction after cataract surgery in eyes that had undergone previous trabeculectomy was different from the predicted refraction. SETTING: University-based tertiary glaucoma service and 3 glaucoma private practices. METHODS: Retrospective, interventional, case-control study. The medical records of patients with glaucoma and medically treated glaucoma suspects who underwent cataract extraction between January 1, 2004 and February 11, 2006 were reviewed. The axial length was measured by contact A-scan ultrasonography. The study group included 27 eyes of 25 patients who underwent phacoemulsification with intraocular lens implantation after trabeculectomy, whereas the control group included 52 eyes of 49 glaucoma patients or medically treated glaucoma suspects who underwent phacoemulsification with intraocular lens implantation only. The main outcome measure was the difference between the postphacoemulsification manifest refraction and predicted refraction between the 2 groups. RESULTS: The difference between the mean final refraction and mean predicted refraction in the study group (-0.852+/-1.056 D) and the control group (-0.501+/-0.542 D) was not statistically significant (P=0.115). The mean intraocular pressure in the study group decreased significantly after trabeculectomy (25.9+/-8.9 to 9.6+/-4.3 mm Hg, P<0.001), and increased significantly after phacoemulsification (9.6+/-4.3 to 12.5+/-5.3, P=0.001). Lower prephacoemulsification intraocular pressure was weakly correlated with a myopic shift in final refraction (r=0.269, P=0.017). CONCLUSIONS: Though numerous variables can potentially influence the refractive outcome in cataract extraction after trabeculectomy, our study shows that the refractive outcome in these cases remained reasonably predictable. However, lower prephacoemulsification intraocular pressure was weakly correlated with a myopic shift in final refraction.

Efficacy of bimatoprost 0.03 percent in untreated glaucoma and ocular hypertension patients: results from a large community-based clinical trial.

PURPOSE: To evaluate the intraocular pressure- (IOP-) lowering efficacy of bimatoprost 0.03% (Lumigan, Allergan, Inc.) monotherapy in the treatment of patients with glaucoma or ocular hypertension not currently using ocular hypotensives. METHODS: Open-label, community-based, multicenter evaluation. Patients (n = 6767) who, according to their physicians, required IOP lowering were prescribed bimatoprost for 2 months. Subgroup analyses of the results, stratified by treatment history and use of concomitant medications, were performed. This report focuses on the subgroup of patients that was not being treated with antiglaucoma medications at baseline (n = 1946, 29%). All of these patients were placed on bimatoprost monotherapy. RESULTS: The mean IOP at the untreated baseline was 23.8 mmHg. Bimatoprost provided a mean IOP reduction of 7.5 mmHg (30%, p < 0.001) from baseline after 2 months of monotherapy. Further, bimatoprost allowed patients to achieve low target pressures. For example, 41.5% of patients achieved target IOPs of < or =15 mmHg after 2 months of bimatoprost monotherapy, and 75.8% of patients reached IOPs of < or =18 mmHg. The most commonly reported adverse event was conjunctival hyperemia (7.9%). CONCLUSION: Bimatoprost monotherapy was well tolerated and reduced IOP by an average of 30% in a large population of untreated patients.

The efficacy of bimatoprost 0.03% monotherapy in patients previously using topical beta-blocker monotherapy for the treatment of glaucoma or ocular hypertension.

In an open-label 12-week study, the safety and efficacy of bimatoprost 0.03% was evaluated in 55 patients with open-angle glaucoma or ocular hypertension inadequately controlled by topical beta-blocker monotherapy. Patients discontinued their topical beta-blocker therapy at the baseline visit and began bimatoprost monotherapy that evening. Study visits were at 6 and 12 weeks postbaseline. Bimatoprost reduced intraocular pressure (IOP) 4.5 mm Hg (21.5%; P < .001) from baseline at week 6 and 4.2 mm Hg (19.6%; P < .001) at week 12. Patients were more likely to achieve low target pressures with bimatoprost than with topical beta-blockers. Conjunctival hyperemia was the most commonly reported adverse event. The findings from this study indicate bimatoprost monotherapy provides a substantially greater IOP reduction than topical beta-blocker therapy and allows more patients to achieve a low target pressure. Bimatoprost is an effective alternative to topical beta-blockers for the treatment of glaucoma and ocular hypertension.

Angle-closure glaucoma in teenagers.

OBJECTIVE: To report the occurrence of angle-closure glaucoma in 2 teenagers. DESIGN: Observational case reports, review of literature. METHODS: Review of case histories, examinations, biometries, visual fields, and ultrasound biomicroscopy findings in 2 teenagers with angle-closure glaucoma. MAIN OUTCOME MEASURES: Intraocular pressure, gonioscopy, Humphrey 24-2 visual field (SITA Standard), and ultrasound biomicroscopy. RESULTS: The first case involved a 15-year-old white male who presented with an intraocular pressure of 60 mm Hg in the right eye and 24 mm Hg in the left eye and 360-degree appositional closure in both eyes. Ultrasound biomicroscopy revealed prominent bilateral ciliary pigment epithelial cysts pushing the iris anteriorly towards the angle. The second case involved a 14-year-old white male with a strong family history of primary angle-closure glaucoma. The patient had pupillary block and an intraocular pressure of 24 mm Hg in the right eye and 40 mm Hg in the left eye on routine eye examination. Gonioscopy and ultrasound biomicroscopy revealed appositional closure of the angle in all 4 quadrants bilaterally. CONCLUSION: Primary angle-closure glaucoma is uncommon in younger individuals. Therefore, the finding of angle-closure glaucoma in a young individual should alert the physician to the possibility of a secondary cause of angle closure, such as iris pigment epithelial cysts. In addition, special attention to family history is important as the configuration of an occludable anterior chamber angle may, in some instances, be inherited.