A Pooled Assessment of Ocular Surface Disease After Switching from Preserved Prostaglandins to Tafluprost Across Six Countries in Asia.

Background: Preserved prostaglandin analogs (PGAs) have been linked to ocular surface disease (OSD). While the benefits of preservative-low (PL) or -free (PF) Tafluprost (Santen Inc., Japan) were reported in real-world studies in Western countries, this is the first study in Asia to assess the effectiveness and safety of switching from preserved PGA to PL or PF-Tafluprost. Methods: We conducted a meta-analysis on studies that included adults (>18 years of age) with a Corneal Fluorescein Staining Score (CFS) >1. These individuals had switched to PL or PF-tafluprost after using a preserved PGA therapy for at least 3 months for glaucoma and were identified from Santen's tafluprost study database. A total of six studies from South Korea, Philippines, Malaysia, Singapore, Thailand, Taiwan were pooled for analysis. Results: An intraocular pressure (IOP) reduction of 5.9% (0.91 mmHg) was seen in 265 patients. However, this result was not statistically significant (95% CI: -3.64, 1.81; Figure 1). Among 132 patients, a 47.9% reduction in the CFS (95% CI: -3.65, -1.91) was seen. Tear film break-up (n=183) significantly increased by 1.06 seconds (95% CI: 0.65, 1.47). In 88 patients, the bulbar conjunctiva score decreased by -0.46 (95% CI: -0.81, -0.10) and palpebral conjunctiva score decreased by -0.42 (95% CI: -0.67-0.17). One or more new adverse reactions were reported in 3% of the individuals after switching. Conclusion: Tafluprost IOP reduction is comparable to other PGAs, with significant improvements in the ocular surface and minimal adverse reactions which were already previously reported.

Progression to blindness in 20 years among patients with glaucomatous visual field loss in a tertiary hospital in the Philippines.

OBJECTIVE: To determine visual field (VF) rates of change among patients with glaucomatous VF loss and proportion of those becoming blind based on residual life expectancy and factors associated with fast progression. METHODS AND ANALYSIS: This was a retrospective study of the VFs of patients with glaucomatous VF defects in at least one eye. Baseline and final VFs were reviewed. Rates of VF change (decibels (dB)/year) for each eye, together with the residual life expectancy based on age and sex, were used to predict mean deviation/defect (MD) at the end of expected lifetime. Blindness was defined if computed MD was 22 dB (Octopus) or -22 dB (Humphrey) or worse in the better eye. Factors associated with fast progression (>1 dB/year for Octopus or <-1 dB/year for Humphrey) and blindness were determined. RESULTS: There were 1016 eyes of 583 patients eligible. There was decline in VF MD/year in 613/1016 (60.3%), 95% CI (57.3% to 63.3%) of eyes; however, only 98/1016 (9.7%), 95% CI (7.9% to 11.5%) of eyes showed fast progression. Among patients with bilateral VFs, 43/433 (9.9%), 95% CI (7.1 to 12.8) of eyes were predicted to progress to blindness. In multivariate analysis, factors associated with fast progression were baseline MD (p<0.001) and male sex (p=0.041). Factors associated with blindness were age <60 years (p=0.003), baseline MD (p=0.022), bilateral glaucomatous VF defects (p=<0.001) and fast progression (p<0.001). CONCLUSION: Patients reaching blindness in a routine clinical setting was 10%. Because of association of age and baseline MD on blindness, early disease detection is important. VF progression rates and residual life expectancy must be incorporated in glaucoma care.

Efficacy and safety of tafluprost 0.0015% - retrospective analysis of real-world data from the Philippines.

PURPOSE: To investigate the IOP lowering effect and safety of tafluprost 0.0015% in a routine clinical setting in the Philippines. PATIENTS AND METHODS: A retrospective review of glaucoma patients receiving tafluprost 0.0015% (BAK 0.001% preserved) with a minimum follow-up of 3 months was conducted. Main outcome measure was the mean IOP change at month 3. Secondary outcome measures included longitudinal IOP assessments and occurrence of any adverse events. RESULTS: Three-hundred twenty-nine eyes of 177 patients with mean age 64.8 years were included and followed for mean 8.8 months. Most common diagnosis was primary open-angle glaucoma (POAG) (34.9%), followed by primary angle-closure (PAC) glaucoma post-laser iridotomy (24.0%), PAC post-laser iridotomy (15.5%), ocular hypertension (OHT)(14.6%), secondary glaucoma (6.7%), and normal-tension glaucoma (4.3%). Mean IOP change at month 3 was -6.18 mmHg (SD 4.06), a -26.37% reduction (p<0.001) and IOP reduction was sustained throughout the study period (p<0.001). Sub-group analysis of treatment naïve (n=203); add-on (n=53) and replacement therapy (n=73) showed a 3-month mean IOP reduction of -8.34 mmHg (SD 2.57, p<0.001) or -31.24%, -5.08 mmHg (SD 2.86, p<0.001) or -23.68%, and -1.00 mmHg (SD 3.08; p=0.007) or -6.31%, respectively. There was significant IOP reduction from baseline in both POAG/OHT sub-group and the PAC/PACG post-laser iridotomy with ≥90° open-angle sub-group (p<0.001), sustained up to month 12 post-treatment. However, there was no significant difference in the average absolute (mmHg) or proportional IOP change from baseline between the two sub-groups. Conjunctival hyperemia was the most common adverse reaction occurring in 15% of patients. CONCLUSION: Tafluprost was a safe and effective IOP-lowering treatment in this routine clinical setting.

Short wavelength automated perimetry and peripapillary retinal nerve fiber layer in early diabetes

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To investigate the significance of short wavelength automated perimetry (SWAP) in detecting retinal functional impairment in early diabetic patients without retinopathy and with mild non-proliferative diabetic retinopathy (NPDR). <br /><br /> <strong>METHODS:</strong> This is a prospective, cross-sectional study of 37 eyes of early diabetics which were divided into 2 groups: no DR with 18 subjects and mild NPDR with 19. All subjects underwent HBA1C, SWAP, peripapillary RNFL thickness measurement and fundus photo. Visual field indices: MD and PSD as well as average RNFL thickness were compared among the 2 groups. Correlation of MD with RNFL thickness and HBA1C were also analyzed. <br /><br /> <strong>RESULTS:</strong> There was no statistically significant difference in the MD (-4.46 ± 3.03 vs -2.94 ± 2.21; p=0.09), PSD (3.08 ± 1.28 vs 2.69 ± 0.47; p=0.23) and average peripapillary RNFL thickness (98.47 ± 6.89 vs 98.72 ± 11.01; p=0.93) among early diabetics with mild NPDR and no signs of DR. There is no correlation between MD and RNFL thickness in the no DR group (R2=0.017) and the mild DR group (R2=0.000). There was a weak correlation between MD and HBA1C in the no DR group (R2=0.137), while no correlation was seen in the mild NPDR group (R2=0.000). <br /><br /> <strong>CONCLUSION:</strong> SWAP does not appear to be a sensitive measure of worsening retinopathy in older individuals with early diabetes. The usefulness of SWAP and peripapillary RNFL thickness in the early stages of retinopathy are inconclusive.</p>

Safety of intracameral moxifloxacin/dexamethasone fixed-dose formulation on the corneal endothelium in a rabbit model

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the safety of intracamerally injected preservative-free 0.5% moxifloxacin/0.1% dexamethasone fixed-dose combination on the corneal endothelium in a rabbit model and compare it to intracamerally injected preservative-free 0.5% moxifloxacin.</p> <p style="text-align: justify;"><strong>METHODS:</strong> This experimental study included twenty eyes from ten albino rabbits. The eyes were assessed for baseline corneal clarity and anterior chamber (AC) inflammation using slit-lamp biomicroscopy. A specular microscope measured the corneal endothelial cell density (ECC) and corneal thickness (CT). Intracameral injections of 0.1 mL 0.5% moxifloxacin ophthalmic solution were administered to the 10 right eyes (IPFM group) and 0.1 mL of 0.5% moxifloxacin/0.1% dexamethasone fixed-dose preparation were administered to the 10 left eyes (IPFMDex group). In both groups, ECC, CT, corneal clarity, and AC inflammation at Day 1 (one day post-injection) and Day 7 (seven days post-injection) were compared with Day 0 (baseline). The IPFMDex group was also compared with the IPFM group at Days 0, 1, and 7. The endothelial cells of harvested corneas from both groups at Day 1 and 7 were stained with trypan blue and alizarin red, and compared for endothelial cell damage (ECD). Data were analyzed using paired and independent sample t-tests.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> In both the IPFM and IPFMDex groups, ECC and CT at Day 1 (IPFM: ECC p=0.07, CT p=0.76; IPFMDex: ECC p=0.41, CT p=0.94) and Day 7 (IPFM: ECC p=0.95, CT p=0.28; IPFMDex: ECC p=0.29, CT p=0.34) were not different from Day 0 (baseline). No significant difference in ECC, CT, and ECD were found between the IPFM and IPFMDex groups at Day 1 (ECC p=0.82, CT p=0.36, ECD p=0.96) and Day 7 (ECC p=0.95, CT p=0.22, ECD p=0.61). Throughout the study, the cornea in both groups were clear and showed no signs of AC inflammation.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> Intracameral injection of preservative-free moxifloxacin/dexamethasone fixed-dose formulation was safe on the rabbit corneal endothelium and was no different from preservative-free moxifloxacin.</p>

Correlation between average retinal nerve fiber layer thickness and rim area of the spectral-domain OCT with the Humphrey visual field index in eyes with glaucoma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the correlation between the average retinal nerve fiber layer (RNFL) thickness and optic nerve head rim area (RA) measured with a spectral-domain optical coherence tomography (OCT) with the visual field index (VFI) using the Humphrey Visual Field Analyzer in glaucoma patients.<br /><strong>METHODS:</strong> Eighty-five consecutive patients diagnosed with glaucoma underwent spectral-domain OCT of the optic disc and Humphrey perimetry. A glaucoma specialist confirmed the presence of glaucomatous optic neuropathy based on findings in the optic nerve head photographs, OCT measurements of the RNFL and optic disc, and standard automated perimetry. The correlation of the average RNFL thickness and rim area with the VFI was determined using the Spearman's correlation coefficient analysis.<br /><strong>RESULTS:</strong> A total of 121 glaucomatous eyes of 85 patients were included in the study. There were 47 males and 38 females, ages ranging from 12 to 94 years. The average RNFL thickness, RA, and VFI were 67.9 ± 12.3 ?m, 0.65 ± 0.3 mm2, and 56 ± 32%, respectively. The average RNFL thickness (r = 0.35) showed a stronger positive correlation with VFI than RA (r = 0.15), but the difference was not statistically significant.<br /><strong>CONCLUSION:</strong> The average RNFL thickness and rim area of the spectral-domain OCT demonstrated a positive correlation with the VFI of the Humphrey Visual Field Analyzer. The OCT parameters, exemplified by average RNFL and RA, were not good indicators for VFI.</p>

Understanding structure and function in glaucoma

OBJECTIVE: Glaucomatous optic neuropathy (GON), defined as definitive damage to the optic-nerve head (ONH) and retinal-nerve-fiber layer (RNFL), involves structural changes in the ONH and RNFL and functional losses in the central visual field. Due to the unique anatomic distribution of the nerve fibers as they enter the ONH, there are specific changes in the ONH correlated with specific findings in the visual-field characteristic of GON. The evaluation of these changes is discussed. METHODS: There are qualitative and quantitative methods in the structural examination of the ONH and RNFL, and quantitative techniques in the functional assessment of the central visual field. They are correlated to one another their strengths and limitations are discussed. RESULTS: Clinical evaluation of the ONH and RNFL consists of five basic rules: (1) identify the limits of the optic disc and determine its size, (2) identify the s of the neuroretinal rim, (3) examine the RNFL, (4) examine the region for parapapillary atrophy, and (5) look for retinal and optic-disc hemorrhages. These steps are simple to use and comprise a portion of the comprehensive eye evaluation. Without proper documentation of the changes in glaucoma progression may be missed. Computer-based digital-imaging technology exemplified by the HRT II, GDx, OCT, provides fast, reproducible, objective measurements of the ONH and RNFL, allowing for more precise diagnosis and monitoring of glaucoma. These changes have good correlation to functional assessments exemplified by the standard automated perimetry (SAP) and the selective perimetry (FDT, SWAP). Typical glaucomatous visu field defects include nasal step, paracentral scotoma, and arcuate defects which follow the RNFL pattern. Progression of these defects is monitored over time and needs to be differentiated from long-term fluctuation. CONCLUSION: The clinician should perform both structural and functional assessments to diagnose and monitor glaucoma. Both examinations provide complimentary information and each has its own place in the clinical care of glaucoma patients. The newer imaging devices and selective perimetry augment the diagnostic armamentarium of the clinician and should, therefore, be used appropriately.

The effect of laser in situ keratomileusis on low contrast vision.

PURPOSE: To determine the effects of laser in situ keratomileusis (LASIK) on low contrast visual acuity. METHODS: Thirty eyes of 15 LASIK patients with myopia and astigmatism were evaluated preoperatively, and 1 and 3 months postoperatively. High contrast visual acuity (HCVA), low contrast visual acuity (LCVA), and contrast threshold were determined. RESULTS: Mean spherical correction (SE) was -3.24 +/- 1.90 D; 16 eyes had a mean SE between -1.00 and -3.00 D, and 14 eyes were between -3.25 and -6.50 D. There was no significant change in HCVA observed at 1 and 3 months in any eye. There was a decrease in LCVA in eyes with a correction >3 D SE at 1 month (P=.04), which returned to normal at 3 months (P=.13). There was an increase in the contrast threshold at 1 month (P=.016). When eyes were divided into groups, those with >3D SE correction had an increase in contrast threshold at 1 month (P=.002); no change was seen in eyes with <3D SE correction (P=.15). At 3 months, contrast threshold was similar to baseline values in all eyes (P=.226). CONCLUSION: LASIK transiently decreased low contrast visual function in patients with greater than 3.00 D of myopic correction.

Late traumatic displacement of laser in situ keratomileusis flaps.

PURPOSE: To report the occurrence, management, and outcome of late-onset traumatic dehiscence and dislocation of laser in situ keratomileusis (LASIK) flaps. METHODS: Two interventional case reports of patients with late-onset LASIK corneal flap dislocation after ocular trauma occurring at 7 and 26 months after surgery, respectively. RESULTS: The flaps were lifted, stretched, and repositioned after irrigation and scraping of the stromal bed and the underside of the flap. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. The dislocated corneal flaps were successfully repositioned in both cases. The patient whose dislocated flap was repositioned 4 hours after the trauma recovered his uncorrected visual acuity (UCVA) of 20/20 1 week after the procedure and had a well-positioned flap with a clear interface. The patient who was managed 48 hours after the injury required repeat flap repositioning at 10 and 24 days after the initial procedure for treatment of persistent folds and striae in the visual axis. His uncorrected visual acuity 2 weeks after the third flap repositioning was 20/40 + 2. Diffuse lamellar keratitis developed in both patients that resolved with the use of topical corticosteroids. CONCLUSION: Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which can occur more than 2 years after the procedure.

Biphasic tricalcium phosphate spheres with muscle resection in primary enucleation

Purpose: To combine the advantage of porosity and biocompatibility of Biphasic Tricalcium Phosphate implant with Muscle Resection Methodology: Non-randomized, uncontrolled clinical case series Results: No migration or extrusion was observed. With improved muscle resection, socket and prosthesis mobility were noted. (Author)

Selective laser trabeculoplasty: a new treatment option for open angle glaucoma.

Selective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering the intraocular pressure in patients with open angle glaucoma. The preservation of the trabecular meshwork architecture and the demonstrated efficacy in lowering intraocular pressure makes the SLT a reasonable and safe alternative to argon laser trabeculoplasty. In addition, SLT is a potentially repeatable procedure because of the lack of coagulation damage to the trabecular meshwork and the demonstrated efficacy in patients with previously failed argon laser trabeculoplasty treatment. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or are noncompliant with their glaucoma medications, while not interfering with the success of future surgery. Due to its nondestructive properties and low complication rate, SLT has the potential to evolve as an ideal first-line treatment in open angle glaucoma.