Comparison between primary Ahmed valve implantation and primary trabeculectomy with mitomycin C in pseudophakic patients with exfoliative glaucoma.

PURPOSE: To compare the efficacy and safety of primary Ahmed valve implantation (AVI) and primary trabeculectomy with mitomycin C (MMC) in patients with pseudophakic exfoliative glaucoma (XFG). METHODS: All enrolled patients were divided into two groups: the TRAB group, comprising patients who underwent trabeculectomy with MMC, and the AVI group, comprising patients who underwent AVI. Intraocular pressure (IOP), mean deviation (MD), endothelial cell density of cornea (ECD), and the number of topical anti-glaucoma agents used during study period were retrospectively analyzed. Surgical success rates were compared between two groups using Kaplan-Meier survival analysis. Three levels of surgical success were defined as follows: (1) IOP ≤ 18 mmHg and an IOP reduction of 20% without medication; (2) IOP ≤ 15 mmHg and an IOP reduction of 25% without medication; and (3) IOP ≤ 18 mmHg and an IOP reduction of 20%, irrespective of medication. RESULTS: The TRAB and AVI groups comprised 40 and 36 patients, respectively. At 36 months postoperatively, IOP was 15.7 ± 2.8 mmHg in the TRAB group and 16.9 ± 3.3 mmHg in the AVI group (p = 0.140). Surgical success rates in the TRAB group were 47.5, 37.5, and 77.5% and those in the AVI group were 41.6, 33.3, and 75.0% at 36 months for surgical criteria 1, 2, and 3, respectively. There were no statistically significant differences in the success rates between the two groups. However, regarding surgical criteria 2, the success rate of the AVI group at 1 year was significantly better than that of the TRAB group (p = 0.030). CONCLUSIONS: Primary AVI was not inferior to primary trabeculectomy with MMC in medically uncontrolled patients with XFG.

The effect of uneventful cataract surgery in pseudoexfoliation glaucoma with or without previous mitomycin C-augmented trabeculectomy.

PURPOSE: To analyze the effect of uneventful cataract surgery on intraocular pressure (IOP) in pseudoexfoliation glaucoma (PXG) eyes with and without a history of Mitomycin C-augmented trabeculectomy. METHODS: Eyes with PXG that had underwent uneventful cataract surgery were enrolled. The IOP and the medication numbers before cataract surgery, and 1, 3, 6, 12, 18, 24 months after cataract surgery, and at the last visit were recorded in PXG with and without previous trabeculectomy. Failure was defined as IOP > 21 or ≤ 21 mmHg with additional medication or surgery. In the postoperative first 24 h, IOP > 50% above baseline was defined as an IOP spike. RESULTS: In the trabeculectomized eyes (n = 37), the increase in the mean IOP (p = 0.024) and the increase in the mean number of medications (p = 0.007) was significant at the last visit when compared with baseline. In the non-trabeculectomized eyes (n = 42) there was a significant decrease in the mean IOP (p = 0.016) and in the mean number of medications (p = 0.038) at the last visit. Twelve eyes (32.4%) in trabeculectomized group and six (14.3%) in the non-trabeculectomized group experienced failure. An IOP spike was seen in one eye in the trabeculectomized group, in 15 eyes in the non-trabeculectomized group (p < 0.0001). The IOP spike was a significant risk factor for failure (p = 0.027). CONCLUSION: Uneventful cataract surgery may have significant negative effect on the IOP control in the trabeculectomized PXG eyes. After cataract surgery, the non-trabeculectomized PXG eyes had a higher risk of IOP spike and an IOP spike may be a risk factor for failure.

Sustained Elevation of Intraocular Pressure After Administration of Intravitreal Anti-Vascular Endothelial Growth Factor Agents in Patients With and Without Pseudoexfoliation Syndrome.

PRéCIS:: Intravitreal anti-vascular endothelial growth factor therapy resulted in sustained elevation of intraocular pressure (IOP) in 18.6% of patients with coexisting age-related macular degeneration and pseudoexfoliation (PXF) syndrome. The development of sustained elevation of IOP after ~19 injections reflected the cumulative effect of anti-vascular endothelial growth factor injections on IOP. PURPOSE: The purpose of this study was to compare the long-term effect of intravitreal ranibizumab (IVR) and intravitreal bevacizumab (IVB) therapies on IOP in patients with and without PXF syndrome. DESIGN: This was a retrospective comparative study. PATIENTS AND METHODS: Data from 412 eyes of 206 patients diagnosed with unilateral neovascular age-related macular degeneration, treated with IVR or IVB, and followed-up for at least 6 months, were retrospectively reviewed. Seventy treated and 70 untreated fellow eyes of 70 patients with bilateral PXF syndrome, and 136 treated and 136 untreated fellow eyes of 136 patients without PXF syndrome were included in this study. Demographic information, clinical findings, total number of IVR and IVB injections, and IOP values at each visit were recorded. Sustained elevation of IOP (SE-IOP) was defined as either an IOP >21 mm Hg or a ≥5 mm Hg increase in IOP from baseline for at least 2 consecutive visits. Baseline and final IOP values in each group were compared using the paired sample t test, and IOP changes in the groups were compared using split-plot analysis of variance. Multivariate logistic regression analysis was used to evaluate the influence of variables on the development of SE-IOP. RESULTS: The mean (±SD) age of the patients was 77.53±3.78 years (range, 70 to 83 y), and the mean follow-up was 28.50±16.51 months (range, 6 to 58 mo). The mean number of injections was 15.56±8.01 (range, 5 to 36). The mean baseline and final IOP in treated eyes were 14.82±3.08 and 16.50±3.11 mm Hg, respectively (P<0.001). A higher incidence of SE-IOP and higher final IOP values were observed in PXF-positive eyes receiving IVB compared with the other groups. Seven of the patients required antiglaucomatous treatment. Multivariate logistic regression analysis revealed an increased odds ratio (4.90; P=0.016) of SE-IOP in PXF-positive eyes compared with PXF-negative eyes. CONCLUSION: IVB therapy may cause greater increases in IOP in patients with PXF syndrome. The co-accumulation of PXF material and bevacizumab particles on the trabecular meshwork should be further investigated.

Prospective randomized clinical trial on the effects of latanoprost, travoprost and bimatoprost on latanoprost non-responders.

PURPOSE: To determine whether a patient who is non-responder to latanoprost after one month of use should continue using latanoprost or switch to either bimatoprost or travoprost. PATIENTS AND METHODS: Prospective randomized clinical trial. We recruited new patients who were felt to require intraocular pressure reduction. Patients who had≤20% intraocular pressure reduction after one month of latanoprost treatment were randomly assigned to another month of treatment with latanoprost or a switch to bimatoprost or travoprost for an additional month. RESULTS: Overall, 83 non-responders to latanoprost after one month of treatment were included in the study. Before latanoprost treatment, the mean intraocular pressure was 23.7±4.7mmHg. At randomization on latanoprost, mean intraocular pressure was 21.5±4.5mmHg. One month after the switch of medication, the mean reduction in intraocular pressure was not significantly different between the groups (P=0.148) and was -0.9mmHg, -2.10mmHg and -2.5mmHg, for latanoprost, bimatoprost and travoprost respectively. One month after randomization, 32 (38.5%) of the patients had become responders, with IOP reduction>20%. Of those patients, 9 (31%) were using latanoprost, 13 (41.9%) bimatoprost and 10 (43.5%) travoprost. The number of new responders was similar between the three groups (P=0.584). CONCLUSION: There is no added benefit of switching latanoprost to another topical prostaglandin for patients who are initially non-responders. Regression towards the mean and the Hawthorne effect are probably important factors explaining the additional IOP reduction obtained after randomization and explain the result of most switch studies.

Initial trabeculectomy with 5-fluorouracil with or without subconjunctival bevacizumab in the management of pseudoexfoliation glaucoma.

PURPOSE: To investigate the outcomes of trabeculectomy with 5-fluorouracil (5-FU) with or without subconjunctival bevacizumab in the surgical management of pseudoexfoliation glaucoma (PXG). METHODS: This retrospective study consisted of 49 cases with PXG who underwent initial trabeculectomy with 5-FU. The cases were divided into two age- and sex-matched groups. In 23 cases, subconjunctival bevacizumab was injected (1.25 mg/0.05 mL) at the end of the surgery and in 26 of them the surgery was performed without bevacizumab. The groups were evaluated for the postoperative differences of the intraocular pressure (IOP) and the number of the anti-glaucomatous medications. Independent t, Kolmogorov-Smirnov and Chi square tests were used for statistical analysis. RESULTS: The mean preoperative IOP was 30.91 ± 4.50 mmHg under the mean number of 2.4 ± 0.7 drops in bevacizumab group. The IOP decreased to 10.22 ± 2.63 mmHg (first week), 10.91 ± 1.88 mmHg (first month), 12.35 ± 2.5 mmHg (3rd month), 12.65 ± 2.35 mmHg (sixth month) and 12.7 ± 1.9 mmHg at the final visit. The mean preoperative IOP was 31.27 ± 5.60 mmHg under the mean number of 2.3 ± 0.7 drops in without bevacizumab group. The IOP decreased to 10.08 ± 2.59 mmHg (first week), 11.00 ± 1.87 mmHg (first month), 12.81 ± 2.04 (3rd month), 13.62 ± 2.21 mmHg (sixth month) and 12.9 ± 2.4 mmHg at the final visit. In both groups, IOP reduced significantly postoperatively. There were no significant differences between the preoperative and the postoperative IOP values. CONCLUSION: The additional benefit of single dose of intraoperative bevacizumab was not observed in trabeculectomy with 5-FU in PXG.

Evaluation of oxidative stress in pseudo-exfoliative glaucoma patients treated with and without topical coenzyme Q10 and vitamin E.

PURPOSE:: To evaluate the levels of oxidative stress markers such as superoxide dismutase and malondialdehyde in eyes with pseudo-exfoliative glaucoma treated with and without topical coenzyme Q10 (CQ10) and vitamin E (Coqun drop). METHODS:: This prospective, randomized clinical study was conducted on 64 eyes of 64 patients. All patients underwent phacoemulsification and intraocular lens implantation surgery. Aqueous humor samples were aspirated from the anterior chamber at the beginning of cataract surgery. The pseudo-exfoliative glaucoma + Coqun group received topical Coqun (100 mg CQ10, 500 mg Vitamin E TPGS) twice daily for 1 month preoperatively, while the pseudo-exfoliative glaucoma group consisted of pseudo-exfoliative glaucoma cases who had not taken Coqun. Pseudo-exfoliation syndrome cases formed the pseudo-exfoliation syndrome group. The main outcomes were the superoxide dismutase and malondialdehyde levels of aqueous humor in both groups. RESULTS:: The mean aqueous humor superoxide dismutase level was significantly higher in the pseudo-exfoliative glaucoma group than in pseudo-exfoliative glaucoma + Coqun and pseudo-exfoliation syndrome groups (p < 0.001, p = 0.004, respectively). Also, the mean aqueous humor superoxide dismutase level was significantly lower in the pseudo-exfoliation syndrome group than in pseudo-exfoliative glaucoma + Coqun group (p = 0.009). The mean malondialdehyde levels showed no significant difference between the groups (p > 0.05 for all). CONCLUSION:: Our study showed lower aqueous humor level of superoxide dismutase in pseudo-exfoliation syndrome patients compared to pseudo-exfoliative glaucoma patients. Significantly lower superoxide dismutase level was observed in pseudo-exfoliative glaucoma patients who received topical Coqun compared to pseudo-exfoliative glaucoma patients without Coqun treatment. No significant change was observed on the malondialdehyde level during 1-month follow-up period.

Micropulse laser trabeculoplasty on pseuodexfoliation glaucoma patients under topical prostaglandin analogue monotherapy: 1-year results.

PURPOSE: To evaluate the effectiveness of a single session of micropulse laser trabeculoplasty (MLT) to lower intraocular pressure (IOP) in patients with pseudoexfoliation glaucoma (PEXG). METHODS: In this single-center, one-arm, prospective study patients with PEXG under prostaglandine analogue monotherapy with inadequate IOP control were treated with 360° 532-nm MLT. Patients were evaluated at 1 day, 1 month, 3 months, 6 months, and 12 months post-MLT while they were treated with the same drug regimen as pre-MLT. Mean IOP reduction and percentage of IOP change during the follow-up were calculated. Cases that required any further intervention, like additional hypotensive medication, laser or surgical therapy, throughout the study period were considered failures and removed from the study. RESULTS: Twenty-seven eyes (27 patients, 17 male) were included in the study. The age of the patients was 72.37 ± 6.29 years and the baseline IOP was 20.41 ± 1.87 mmHg. Treatment with MLT resulted in significantly lower IOP at 1, 3, 6, and 12 months after MLT compared to baseline (p < 0.0001 for all comparisons). By the end of the study, 52.17% of the PEXG eyes demonstrated a ≥ 20% IOP reduction compared to baseline. Four eyes (14.81%) did not respond to MLT (three eyes at 3 months and one eye at 6 months after trabeculoplasty) and were considered failures since they required additional intervention. CONCLUSIONS: Micropulse laser trabeculoplasty appears to be an effective method to lower IOP in patients with PEXG up to 12 month of follow-up period. TRIAL REGISTRATION: The study is registered on www.ClinicalTrials.gov with registration number NCT03483402.

Intraocular Pressure Lowering Effect of Latanoprost as First-line Treatment for Glaucoma.

PURPOSE: The purpose of this study was to assess the intraocular pressure (IOP) - reducing effect of latanoprost in treatment-naïve patients with newly detected open-angle glaucoma with no restriction of the level of untreated IOP. METHODS: Eighty-six patients (105 eyes) with a diagnosis of open-angle glaucoma received IOP-lowering therapy with latanoprost. The IOP reduction 1 and 3 months after initiation of treatment was recorded. RESULTS: Mean untreated IOP for all eyes was 26.2 mm Hg (ranging from 10 to 51 mm Hg). The mean pressure reduction was 7.9 mm Hg (28%), with equivalent average levels at 1 and 3 months. The reduction in IOP ranged from -2.3 to 25.3 mm Hg after 1 month, and from -1.3 to 33.3 mm Hg after 3 months. The pressure-lowering effect was considerably more pronounced in eyes with higher untreated IOP; the reduction increased by 0.55 mm Hg per mm Hg higher untreated IOP. Four eyes, with untreated IOP within statistically normal limits, had no or negative IOP-reduction. A regression model predicted that IOP reduction ended at untreated IOP≤16 mm Hg. Multiple regression analysis showed that an additional IOP-lowering effect of 1.28 mm Hg was achieved in eyes with pseudoexfoliation glaucoma. CONCLUSIONS: To the best of our knowledge, this paper is the first to report the IOP-reducing effect of latanoprost treatment at all untreated IOP levels in newly detected glaucoma patients. The effect was proportional to the untreated IOP at all levels above 16 mm Hg and better at higher untreated IOP levels, also in relative terms. Our results further confirm the indication of latanoprost as a first-line therapy for glaucoma.

Medical Management of Glaucoma in Exfoliation Syndrome.

The treatment of glaucoma in exfoliation syndrome is similar to primary open-angle glaucoma. Frequently, exfoliation glaucoma (XFG) patients require early polytherapy with topical medications. Little emphasis has been placed on tailoring treatment specifically to XFG. New outflow enhancing agents with novel mechanisms of action, such as Rho Kinase inhibition, NO signaling (both recently FDA-approved drugs) and adenosine α1-receptor stimulation, act directly on the trabecular meshwork. These agents may prove to be effective in lowering intraocular pressure and perhaps altering the pathogenesis of XFG aid in the long-term management of this disease.

Intravenous Hypertonic Saline to Lower Intraocular Pressure in Ocular Hypertension and Primary Open-angle and Exfoliation Glaucoma.

PURPOSE: The purpose of this article was to quantitate the effect of intravenous hypertonic saline (IVHTS) on elevated intraocular pressure (IOP) among 3 groups of glaucoma patients or suspects. MATERIALS AND METHODS: Among the forty-four patients with IOP 24 to 30 mm Hg included in this study, 13 had ocular hypertension (OHT), 14 primary open-angle glaucoma (POAG), and 17 exfoliation glaucoma (ExG). Participants received a bolus of 23.4% IVHTS (1.0 mmol/kg) through an antecubital vein. We measured IOP, heart rate, and blood pressure before the bolus, thereafter every minute for 10 minutes, and less frequently for 2 hours. RESULTS: The median baseline IOP was 24 mm Hg (range, 24 to 30 mm Hg), 26.5 mm Hg (range, 24 to 30 mm Hg), and 26 mm Hg (range, 24 to 30 mm Hg) in OHT, POAG, and ExG patients, respectively. Sixteen minutes after the bolus, IOP was a median of 9 mm Hg (range, 4 to 12 mm Hg), 10 mm Hg (range, 6 to 12 mm Hg), and 10 mm Hg (range, 4 to 14 mm Hg) lower in OHT, POAG, and ExG groups (P=0.70), respectively. After 1 hour, the median IOP reduction was similar between ExG (9 mm Hg; range, 4 to 14 mm Hg) and POAG patients (9.5 mm Hg; range, 6 to 12 mm Hg) but lower in OHT patients (6 mm Hg; range, 2 to 9 mm Hg; P=0.006). Heart rate decreased by a median of 7 beats/min. Blood pressure increased within 3 minutes (median, mm Hg; 15 systolic; 5 diastolic), but returned to baseline at 10 minutes. Within 1 to 3 minutes of treatment, 36 (82%) patients felt pain in the infusion arm, and 29 (66%) reported a feeling of warmth in their head. CONCLUSIONS: IVHTS reduced IOP effectively in all groups.

[Multi-level analysis of the prevalence of pseudoexfoliative syndrome and pseudoexfoliative glaucoma]. / Vozmozhnosti i otsenka éffektivnosti gipotenzivnoi terapii pri psevdoéksfoliativnom sindrome.

Epidemiological investigation of pseudoexfoliative syndrome (PEX) as a glaucoma predictor is necessary for antiglaucoma treatment planning. AIM: To study the prevalence of PEX and pseudoexfoliative glaucoma (PXFG) among healthy people, naïve patients, and patients under observation as well as to evaluate the hypotensive efficacy of bimatoprost/timolol fixed combination (FCBT) over 4 months in PXFG. MATERIAL AND METHODS: Epidemiological analysis, ophthalmological examination, statistical analysis. RESULTS: The prevalence of PEX among healthy Novosibirsk and Novosibirsk region citizens is 19.9%. In ophthalmologically compromised population and first-time patients, the prevalence of PEX is 24%, of which PXFG constitutes 57.2%. Retrospectively, the prevalence of PXFG in PEX patients who were treated and followed up appeared to be as high as 60.8%. PXFG also accounts for 70% of all open-angle glaucoma cases in the Novosibirsk region, which is much higher than the corresponding rates in the European part of Russia. A 4-month FCBT therapy in 5 groups of PXFG patients (no treatment, monotherapy, another fixed combination, two drugs, three drugs) has yielded an evident hypotensive effect in most patients. The decrease in intraocular pressure was clinically significant in all groups. CONCLUSION: There has been found a high prevalence of PEX and PXFG in the Novosibirsk region. FCBT has demonstrated high hypotensive efficacy at all stages of PXFG and was beneficial even in patients treated with other medications or fixed combinations and in refractory cases.

Efficacy of Ripasudil as a Second-line Medication in Addition to a Prostaglandin Analog in Patients with Exfoliation Glaucoma: A Pilot Study.

OBJECTIVE: This study aimed to assess the intraocular pressure (IOP)-lowering effects of ripasudil, a Rho kinase inhibitor, as a second-line medication in patients with exfoliation glaucoma. METHODS: This retrospective cohort study included patients with exfoliation glaucoma who received ripasudil as the second-line drug in addition to prostaglandin analogs, and were followed-up for at least 5 months. Twenty-seven eyes of 16 patients were enrolled; the mean (±standard deviation) age was 76.1 ± 7.2 years (range 63-91 years). Baseline IOPs were the averages of three IOP measurements performed before ripasudil treatment. Statistical analyses used the paired t test with the Bonferroni correction. Relevant background factors were analyzed via stepwise, multiple regression analysis. RESULTS: The mean (±standard deviation) IOP levels prior to commencement of ripasudil, 1-2 months later, and 5-6 months later were 16.2 ± 2.1, 14.7 ± 2.8, and 13.1 ± 2.6 mmHg, respectively. These levels differed significantly (p = 0.00019 for 0 versus 1-2 months, 0.00087 for 1-2 vs. 5-6 months, and <0.00001 for 0 vs. 5-6 months). Stepwise multiple regression analysis on data from all 27 eyes showed that the change in IOP at 5-6 months was associated with the treatment time with prostaglandin analogs and age, but not with baseline IOP, the severity of the visual field defect, the timing of IOP measurement, or pseudophakic status. CONCLUSIONS: Ripasudil significantly lowered IOP in patients with exfoliation glaucoma, and the effect thereof increased over time within 5 months.

Bromfenac ophthalmic solution 0.09% as an adjunctive therapy to topical steroids after cataract surgery in pseudoexfoliation syndrome.

PURPOSE: To study with laser flare photometry the antiinflammatory effect of bromfenac added to a topical steroid versus a topical steroid alone in patients with pseudoexfoliation (PXF) syndrome after cataract surgery. SETTING: Ophthalmology Unit, Santa Maria Nuova Hospital, Reggio Emilia, Italy. DESIGN: Randomized clinical trial. METHODS: Patients with cataract and clinical signs of PXF were randomized to dexamethasone 0.1% and tobramycin 0.3% ophthalmic solution (Group 1) or with the adjunct of bromfenac ophthalmic solution 0.09% (Group 2). All patients were examined on the day of surgery (baseline) and postoperatively at 1, 3, 7, and 30 days. Laser flare photometry was used to quantify anterior chamber inflammation and optical coherence tomography to measure macular thickness. RESULTS: Sixty-two patients were included. Postoperatively, the mean flare was 31% lower in Group 2 than in Group 1 at 3 days (11.92 ph/msec ± 8.14 [SD] versus 17.13 ± 9.03 ph/msec; P = .025) and 43% lower at 7 days (10.77 ± 6.17 ph/msec versus 18.72 ± 12.37 ph/msec; P = .003). There were no significant differences in postoperative visual acuity, symptoms, or ocular pain between groups. The mean macular thickness 1 month after surgery was increased in Group 1 but not Group 2; the difference between groups was significant at 4 weeks (P = .03). The incidence of intraretinal cysts was higher in Group 1 (n = 4) than in Group 2 (n = 0). CONCLUSION: The addition of bromfenac to topical steroids after cataract surgery in eyes with PXF was associated with greater reductions in inflammation than steroids alone. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Efficacy of Topically Administered Rho-Kinase Inhibitor AR-12286 in Patients With Exfoliation Syndrome and Ocular Hypertension or Glaucoma.

PURPOSE: To evaluate the efficacy of rho-associated protein kinase inhibitor, AR-12286 topical solution, for its effect in eyes with exfoliation syndrome (XFS) and ocular hypertension (OHT) or exfoliative glaucoma (XFG) and examine any lasting effect on intraocular pressure (IOP) after discontinuation. METHODS: Prospective, double-masked, randomized, interventional study. Patients with XFS and OHT or XFG were enrolled. The study eyes were treated once daily with AR-12286, randomized to 0.5% or 0.7% for 24 weeks. Visits included baseline, 1, 4, and 12 weeks after drug initiation; at 12 weeks AR-12286 was discontinued for 1 week and was resumed at week 13. At the week 24 visit, AR-12286 was discontinued, and a final reexamination was performed at week 25. RESULTS: Ten patients were treated. Mean baseline IOP was 25±2.4 mm Hg, mean IOP was reduced to 19.1±2.3 mm Hg at 1 week (P<0.001), 17.5±3.6 mm Hg at 4 weeks (P<0.001), and 17.4±3.6 mm Hg at 12 weeks (P<0.001), yielding an average IOP reduction of 23.6%, 30%, and 30.4%, respectively. At the week 13 visit, 1 week after the drug was discontinued, mean IOP increased to 21.6±5.4 mm Hg (P=0.06 compared with baseline visit). At week 24, the mean IOP was 21.8±7.8 mm Hg (P=0.2, and AR-12286 was discontinued). At week 25, the mean IOP was 21.3±5.3 mm Hg (P=0.06). CONCLUSIONS: AR-12286 was well tolerated and provided statistically significant reduction in IOP in patients with XFS and OHT or XFG. This drug may represent an additional therapeutic paradigm for the treatment of XFG.

Reproducibility of the water-drinking test in patients with exfoliation syndrome and exfoliative glaucoma.

PURPOSE: To evaluate the reproducibility of intraocular pressure (IOP) peaks and fluctuations detected during the water-drinking test (WDT) in patients with exfoliation syndrome (XFS) and exfoliative glaucoma (XFG). METHODS: This prospective study included 34 XFS and 30 XFG patients. Each patient was evaluated twice, with the two WDTs performed on a 30-day interval. We recorded IOP peak (highest IOP during the WDT) and IOP fluctuation (IOP peak minus IOP before the test). Bland-Altman analysis was applied to assess the agreement of IOP peaks and fluctuations between the two consecutive visits. We defined reproducible as within 4 mmHg for IOP peak and within 2 mmHg for IOP fluctuation. RESULTS: There were no significant differences in IOP values, IOP peaks and IOP fluctuations between the two visits for both XFS and XFG patients (p > 0.05, for all). The coefficient of repeatability for IOP peak was 2.5 mmHg and 3.5 mmHg in XFS and XFG patients respectively and for IOP fluctuation, it was 2.1 mmHg and 2.2 mmHg. None of the XFS or XFG patients had an IOP peak difference higher than 4 mmHg. Intraocular pressure (IOP) fluctuation differences above 2.0 mmHg were found in 8.8% of XFS patients and 16.6% of XFG patients. CONCLUSIONS: Intraocular pressure (IOP) peak and IOP fluctuation have a reproducibility, both in XFS and in XFG.

Effects of dorzolamide/timolol fixed combination on retrobulbar hemodynamics in pseudoexfoliative glaucoma.

In our study we aimed to evaluate the short-term effects of dorzolamide/timolol on ocular perfusion pressure and retrobulbar blood flow in patients with pseudoexfoliative glaucoma (PXG). This prospective observational cross-sectional study enrolled 22 eyes of 22 newly-diagnosed patients with PXG in a single center. All of the patients received a fixed combination of dorzolamide/timolol. Besides routine ophthalmologic examination, the retrobulbar hemodynamic parameters in the ophthalmic artery, central retinal artery, and short posterior ciliary arteries were measured in all participants at baseline and the 3(rd) month using color Doppler imaging. The mean intraocular pressure (IOP) was 22.3 ± 2.1 mmHg at baseline and reduced to 17.4 ± 2.3 mmHg at the 3(rd) month (p < 0.05). None of the retrobulbar parameters, except peak systolic velocity and resistive index in temporal short posterior ciliary arteries, changed significantly on therapy with dorzolamide/timolol fixed combination when the results were analyzed at Month 3. The drug significantly decreased the peak systolic velocity (p = 0.044) and reduced the resistive index in 0.04 units, 95% confidence interval 0.03-0.05, (p < 0.001) in the temporal short posterior ciliary arteries. This study reports that the retrobulbar hemodynamics might be affected less than expected by dorzolamide/timolol fixed combination in patients with PXG although the reduction of IOP was statistically significant.

Anterior chamber aqueous flare, pseudoexfoliation syndrome, and glaucoma.

The purpose of this study is to evaluate anterior chamber aqueous flare (ACAF) in Tunisian patients with pseudoexfoliation (PEX) syndrome with or without associated glaucoma. This is a prospective, cross-sectional, comparative study including 53 patients (88 eyes) with PEX syndrome, 48 patients with PEX glaucoma (86 eyes), and 53 healthy sex-and age-matched control subjects (106 eyes). All patients underwent a complete ophthalmic examination and laser flare photometry. Mean ACAF was significantly higher in the PEX syndrome group in comparison with the control group (17.96 ± 10.05 vs 7.06 ± 2.95 ph/ms; p = 10(-4)), in patients with PEX glaucoma compared to PEX syndrome without associated glaucoma (27.99 ± 15.45 vs 17.96 ± 10.05 ph/ms; p = 10(-4)), in the PEX glaucoma group in comparison with control group (27.99 ± 15.45 vs 7.06 ± 2.95 ph/ms; p = 10(-4)), and in patients with unilateral PEX syndrome in comparison with contralateral-unaffected eyes (25.72 ± 14.88 vs 8.58 ± 3.45 ph/ms; p = 0.000). For patients with PEX syndrome, a high ACAF might be a predictor for the development of glaucoma. Further investigations are needed to clarify the role of laser flare photometry in predicting the risk of glaucoma in patients with PEX syndrome.

Nanotechnology Applications for Glaucoma.

Glaucoma is the second leading cause of blindness worldwide, and the antiglaucoma treatments currently available suffer from various complications. Nanotechnology-based treatments show a great deal of promise in overcoming these complications and form the basis for next-generation glaucoma treatment strategies, with the help of applications such as controlled release, targeted delivery, increased bioavailability, diffusion limitations, and biocompatibility. Significant progress has been made in nanomedicine in the efficiency of antiglaucoma medications, nanofabrication systems such as microelectromechanical systems that remove the limitations of nanodevices, and tissue regeneration vesicles for developing glaucoma treatments not based on intraocular pressure. With the use of these advanced technologies, the prevention of glaucoma-induced blindness will be possible in the near future. Herein, we reviewed the recent advances in nanotechnology-based treatment strategies for glaucoma.

Short-term Results of Trabeculectomy Using Adjunctive Intracameral Bevacizumab: A Randomized Controlled Trial.

PURPOSE: To investigate the outcome of trabeculectomy with or without adjunctive intracameral bevacizumab. MATERIALS AND METHODS: In this prospective, double-blind, randomized clinical trial, 71 patients with primary open-angle or pseudoexfoliation glaucoma were randomly assigned to receive either 1.25 mg intracameral bevacizumab (n=36) or balanced salt solution as placebo (n=35) at the end of trabeculectomy. Success was defined as at least a 30% drop in intraocular pressure (IOP) compared with baseline values and an IOP between 6 and 21 mm Hg at the last postoperative visit with (qualified) or without (complete) glaucoma medications. RESULTS: Thirty-two patients in bevacizumab group and 33 in placebo group completed a mean follow-up of 10.7±2.1 and 10.5±2.5 months, respectively (P=0.731). The mean preoperative IOP was 28.25±5.64 and 29.11±4.65 mm Hg in the bevacizumab and placebo groups, respectively (P=0.485). Last visit IOP was 14.5±3.7 mm Hg in the bevacizumab group and 18.55±3.64 mm Hg in the placebo group (P<0.001). At last visit, complete success was achieved in 26 cases (81.3%) of bevacizumab group and 16 cases (48.5%) of placebo group (P<0.006). Filtering bleb leak during the first postoperative month was seen in 11 (34%) and in 3 (9%) cases of bevacizumab and placebo groups, respectively (P=0.013). CONCLUSIONS: A single 1.25 mg dose of intracameral bevacizumab significantly improves the success of trabeculectomy; however, it increases the risk of early filtering bleb leakage.

Association of total antioxidants level with glaucoma type and severity.

OBJECTIVES: To compare the mean total antioxidant status (TAS) among 3 glaucoma types, namely: pseudoexfoliation glaucoma (PEG), primary open angle glaucoma (POAG), and primary angle closure glaucoma (PACG), and study its potential association with various clinical glaucoma-parameters.   METHODS: In this case-control study, plasma samples were obtained between September 2013 and October 2014 from 340 glaucoma patients (PEG [n=54]; POAG [n=147]; PACG [n=139]), and 351 controls of matching age, gender, ethnicity, and 5 different systemic co-morbidities from King Abdulaziz University Hospital, Riyadh, Saudi Arabia. The TAS in all samples was determined by a colorimetric-based assay.   RESULTS: The mean±standard deviation of TAS was significantly lower among cases: 0.77±0.32  than controls: 1.1±0.22, p less than 0.0001. Moreover, the TAS levels were significantly different across the 3 types of glaucoma: 0.86±0.24 in PEG, 0.47±0.32 in POAG, and 0.98±0.41 in PACG (all p less than 0.0001). In addition, there was a significant correlation between TAS and age at onset (Pearson correlation coefficient [R] 0.17, p less than 0.0001), cup/disc ratio (R: -0.13, p=0.004), and number of anti-glaucoma medications (R: -0.16, p=0.001).   CONCLUSION: Our findings provide evidence that plasma TAS levels are decreased in patients with glaucoma, more so in POAG and PEG than PACG, supporting the hypothesis that decreased antioxidative defense and/or increased oxidative stress may have a critical role in the pathogenesis of glaucoma.