Levels of bimatoprost acid in the aqueous humour after bimatoprost treatment of patients with cataract.

AIM: To determine the aqueous humour concentration of the acid hydrolysis products of bimatoprost and latanoprost after a single topical dose of bimatoprost 0.03% or latanoprost 0.005% in humans. METHODS: Randomised, controlled, double-masked, prospective study. 48 eyes of 48 patients scheduled for routine cataract surgery were randomised in an 8:2:2 ratio to treatment with a single 30 mul drop of bimatoprost 0.03%, latanoprost 0.005% or placebo at 1, 3, 6 or 12 h before the scheduled cataract surgery. Aqueous humour samples were withdrawn at the beginning of the surgical procedure and analysed using high-performance liquid chromatography-tandem mass spectrometry. RESULTS: Bimatoprost acid (17-phenyl trinor prostaglandin F2alpha) was detected in aqueous samples at a mean concentration of 5.0 nM at hour 1, 6.7 nM at hour 3 and 1.9 nM at hour 6 after bimatoprost treatment. After latanoprost treatment, the mean concentration of latanoprost acid (13,14-dihydro-17-phenyl trinor prostaglandin F2alpha) in aqueous samples was 29.1 nM at hour 1, 41.3 nM at hour 3 and 2.5 nM at hour 6. Acid metabolites were below the limit of quantitation in all samples taken 12 h after dosing and in all samples from placebo-treated patients. None of the samples from latanoprost-treated patients contained quantifiable levels of non-metabolised latanoprost. Non-metabolised bimatoprost was detected in aqueous samples at a mean concentration of 6.6 nM at hour 1 and 2.4 nM at hour 3 after bimatoprost treatment. CONCLUSIONS: Low levels of bimatoprost acid were detected in aqueous humour samples from patients with cataract treated with a single dose of bimatoprost. Latanoprost acid concentrations in samples from patients treated with latanoprost were at least sixfold higher. These results suggest that bimatoprost acid in the aqueous humour does not sufficiently account for the ocular hypotensive efficacy of bimatoprost.

Clinical experience with the Baerveldt 250-mm2 Glaucoma Implant.

PURPOSE: To report the intermediate-term results of the Baerveldt 250-mm2 Glaucoma Implant for treatment of adult glaucoma. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: One hundred eight adult patients (108 eyes) with glaucoma who received a Baerveldt 250-mm2 Glaucoma Implant. INTERVENTION: Implantation of the Baerveldt 250-mm2 Glaucoma Implant. MAIN OUTCOME MEASURES: Intraocular pressure (IOP), visual acuity, number of glaucoma medications, and surgical complications. Success was defined as IOP > or = 6 mmHg and < or = 21 mmHg (with or without antiglaucoma medications), without further glaucoma surgery, devastating complication, or loss of light perception attributable to drainage implantation. RESULTS: Mean age was 63.8+/-16.5 years. Mean postoperative follow-up was 22.8 months (range, 0.2-84.9; interquartile range, 3.9-36.3). Mean preoperative IOP was 36.3+/-13.0 mmHg, on 2.9+/-1.1 antiglaucoma medications. The mean postoperative IOP at final visit was 15.8+/-7.6 mmHg (P<0.0001, paired t test), on 0.8+/-1.0 antiglaucoma medications (P<0.0001, Wilcoxon test). Kaplan-Meier success rates were 0.92 (6 months, n = 81), 0.88 (12 months, n = 75), 0.84 (18 months, n = 68), and 0.79 (24 months, n = 61). CONCLUSIONS: The Baerveldt 250-mm2 Glaucoma Implant provides good intermediate-term success for the treatment of adult refractory glaucoma.

Ocular hypotensive efficacy of bimatoprost 0.03% and travoprost 0.004% in patients with glaucoma or ocular hypertension.

PURPOSE: To evaluate the IOP-lowering efficacy of bimatoprost and travoprost for the treatment of glaucoma and ocular hypertension. METHODS: Randomized, investigator-masked, parallel-group clinical trial. After completing a washout from all glaucoma medications, patients (n=26) were randomized to bimatoprost or travoprost for 6 months. Visits were at baseline, week 1, and months 1, 3, and 6. IOP was measured at 9 am at each visit and also at 1 and 4 pm at baseline and months 3 and 6. RESULTS: At the baseline visit, there were no significant between-group differences in IOP at 9 am, 1 pm, or 4 pm (P> or =.776). After 6 months of therapy, both medications provided significant mean reductions from baseline IOP at every time point (P< or =.007). Mean IOP reductions ranged from 7.4 mm Hg to 8.8 mm Hg (34% to 36%) with bimatoprost and from 4.6 mm Hg to 7.2 mm Hg (19% to 29%) with travoprost (P> or =.057) after 6 months of medication. At the final study visit, more patients achieved low target pressures with bimatoprost than with travoprost at each time point. Both study medications were well tolerated and ocular redness was the most commonly reported adverse event in both treatment groups. CONCLUSION: Although both bimatoprost and travoprost effectively lowered IOP in patients with glaucoma or ocular hypertension, bimatoprost provided larger mean IOP reductions than travoprost. More patients achieved low target pressures with bimatoprost than with travoprost. The between-group differences were not statistically significant due to the small sample size. These findings are being further evaluated in an ongoing multicenter clinical trial.

Morphologic classification of filtering blebs after glaucoma filtration surgery: the Indiana Bleb Appearance Grading Scale.

PURPOSE: To establish a new classification system for filtering blebs according to clinical morphologic parameters. The purpose of this classification system is to provide a uniform and objective assessment of bleb appearance and establish a framework system through which outcomes of filtration surgery may be better correlated to clinical morphology. MATERIALS AND METHODS: The Indiana Bleb Appearance Grading Scale contains a set of photographic standards illustrating a range of filtering bleb morphology selected from the slide library of the Glaucoma Service at the Indiana University Department of Ophthalmology. These standards consist of slit lamp images for grading bleb height, extent, vascularity, and leakage with the Seidel test. For grading, the morphologic appearance of the filtration bleb is assessed relative to the standard images for the 4 parameters and scored accordingly. Fifty-one clinical bleb photographs were evaluated and scored by 3 glaucoma subspecialists in a masked fashion according to the scale. RESULTS: For all of the grading scales, high interobserver agreement was found using the scale to classify the appearance of filtering blebs (height +0.76; extent +0.78; vascularity +0.90, interclass correlation coefficient for consistency using a 2-way mixed effect model). CONCLUSION: The Indiana Bleb Appearance Grading Scale is a simple, reproducible, yet comprehensive system for classifying the morphologic slit lamp appearance of filtration blebs.