Two-Year Outcomes of Ultrasound Cyclo Plasty as a First Procedure in Glaucoma.

PURPOSE: To evaluate the 2-year outcomes of ultrasound cyclo plasty (UCP) as a first procedure in glaucoma. METHODS: This retrospective cohort study included patients with uncontrolled glaucoma who underwent UCP as an initial glaucoma procedure. The main outcome measures were intraocular pressure (IOP), the number of antiglaucoma medications, visual acuity, and the presence of vision-threatening complications. Surgical outcomes of each eye were classified as either complete success, qualified success, or failure based on the main outcome measures. Differences in IOP control and success rates were compared in eyes with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). RESULTS: We included 98 eyes of 88 patients in the study. The mean follow-up period was 27.25 ± 10.1 months. At 12 and 24 months, mean IOP decreased significantly from 23.16 ± 6.4 mmHg to 16.57 ± 6.0 mmHg and 16.18 ± 5.2 mmHg, respectively, and the number of antiglaucoma medications decreased from 3.27 ± 0.9 to 1.86 ± 1.4 and 1.70 ± 1.7, respectively (p < .01 for all). There were no changes in visual acuity throughout the follow-up compared with preoperative levels. The cumulative probabilities of success were 64.3% (±4.8) [78.9% (±9.4) complete success, and 72.9% (±6.4) qualified success], and 42.9% (±5.0) [52.6% (±11.5) complete success, and 56.3% (±7.2) qualified success] at 12 and 24 months, respectively. The most common complications were cataract development/progression, anterior chamber inflammation, and macular edema. There were no significant differences in IOP, number of antiglaucoma medications, or survival rates between POAG and PACG groups. CONCLUSIONS: UCP can be used as an initial glaucoma procedure for reducing IOP and the number of antiglaucoma medications and offers comparable outcomes in POAG and PACG.

The glaucoma intensive treatment study: interim results from an ongoing longitudinal randomized clinical trial.

PURPOSE: The aim of the study was to determine the perimetric rate of glaucoma progression in the ongoing Glaucoma Intensive Treatment Study (GITS) after 3 years of follow-up. DESIGN: This is a randomized, two-centre, prospective open-labelled treatment trial for open-angle glaucoma (OAG). PARTICIPANTS: The participants of this study were treatment-naive patients with newly diagnosed OAG, aged 46-78 years, with early to moderate glaucomatous visual field loss scheduled to be followed for 5 years within the study. METHODS: Patients were randomized to initial treatment with either topical monotherapy or with an intensive approach using drugs from three different classes, plus 360° laser trabeculoplasty. Changes in treatment were allowed. Standard automated perimetry and tonometry were performed and side-effects documented. All results are presented using intention-to-treat analysis. RESULTS: A total of 242 patients were randomized. After 3 years of follow-up, eight patients were lost to follow-up, six of whom were deceased. The median untreated baseline intraocular pressure (IOP) was 24 mmHg in both arms. The median IOP was almost constant over the 3 years of follow-up: ≈17 mmHg in the mono-arm and ≈14 mmHg in the multi-treatment arm. Treatment was intensified in 42% of the mono-treated patients and in 7% of the multi-treated patients. Treatment was reduced in 13% of the multi-treated patients. The median perimetric rate of progression was -0.5%/year in the mono-treated group and -0.1%/year in the multi-treated group (p = 0.03). CONCLUSION: The rate of disease progression was significantly slower in the multi-treated patients than in the mono-treated patients. Further follow-up will show whether this difference is sustained over time.

New antiglaucomatous agent for the treatment of open angle glaucoma: Polymeric inserts for drug release and in vitro and in vivo study.

A benzamidine derivative from diminazene was tested for a novel activity: treatment of primary open-angle glaucoma. This drug was incorporated into mucoadhesive polymeric inserts prepared using chitosan (Chs) and chondroitin sulfate (CS). Of current interest is the mucoadhesion, which increases the contact time with the ocular surface, resulting in improved bioavailability; also, the inserts are made to act as a prolonged release system. In the present work the inserts were prepared by the solvent casting method using different polymeric proportions (30:70, 50:50, 75:25% w/w Chs:CS and 100% Chs). Thermal analysis and infrared spectroscopy both demonstrated physical dispersion of the active drug. The most promising was the 50:50% Chs:CS which demonstrated that it was not fragile and has an in vitro release profile of up to 180 minutes. In addition, it presented greater adhesion strength in relation to the other formulations. These physicochemical results corroborate the in vivo tests performed. In this sense, we also demonstrated that the treatment with the 50:50% insert can control the intraocular pressure (IOP) for at least 3 weeks and prevents damage to the retinal ganglion cells (RGCs) compared to the placebo insert. Thus, this indicates thus that the new drug is quite viable and promising in glaucoma treatment.