Glaucoma treatment with once-daily levobunolol.

Although twice-daily instillation of topical beta-blockers is the standard regimen for treatment of increased intraocular pressure, once-daily therapy might improve patient compliance and provide greater safety. In a three-month, double-masked clinical trial, 92 patients with open-angle glaucoma or ocular hypertension received levobunolol 0.5% or 1% or timolol 0.5% once daily, in both eyes. Overall mean decreases in intraocular pressure were significantly greater in the groups treated with levobunolol than in the group treated with timolol. Intraocular pressure decreases averaged 7.0 mm Hg with levobunolol 0.5%, 6.5 mm Hg with levobunolol 1%, and 4.5 mm Hg with timolol. The intraocular pressures of 72% (18 of 25 patients) of those treated with levobunolol 0.5%, 79% (22 of 28 patients) of those treated with levobunolol 1%, and 64% (16 of 25 patients) of those treated with timolol were successfully controlled during the study. Heart rate and blood pressure decreases were minimal with both levobunolol and timolol. Study results indicated that once-daily treatment with levobunolol and, to a lesser extent, timolol is sufficient to control intraocular pressure successfully and safely.

Transscleral YAG laser photocoagulation for uncontrollable glaucoma in corneal patients.

Control of intraocular pressure (IOP) in patients with severe alkaline burns is one of the most difficult problems facing the corneal specialist. Currently, when medical therapy cannot control intraocular pressure, the usual procedure of choice is cyclocryotherapy. This procedure, however, can be complicated by phthisis, retinal detachment, or macular edema. We have used transscleral YAG laser cyclophotocoagulation (TSYLC) to control the IOP in a patient with severe glaucoma after an alkali burn. This patient had previously had an unsuccessful cyclocryotherapy. After the TSYLC procedure, he suffered no complications and his IOP was normal. Our experience with this patient indicated that the TSYLC procedure might be an effective alternate to cyclocryotherapy, especially in corneal patients with uncontrollable inflammatory glaucoma.

In vivo non-invasive studies on the human lens.

Progress in biophysical technology now permits us to monitor aging and precataractous changes in the human ocular lens in vivo as well as in vitro. We are employing two noninvasive techniques to measure changes in lens fluorescence and in one lens water compartment (T2) utilizing Scheimpflug lens fluorescence densitography and magnetic resonance imaging. These studies demonstrate age-related changes in the normal lens as reflected by enhanced fluorescence and longer T2 values. Precataractous changes can also be detected with this approach.

Toxicity of dipivalyl epinephrine.

Fourteen patients with open-angle glaucoma applied one drop 0.1% dipivalyl epinephrine topically twice daily for three years. Four of the 14 patients developed severe blepharoconjunctivitis after 17 to 26 months of exposure to this epinephrine prodrug. Two of the four patients with dipivalyl epinephrine intolerance had a history of epinephrine intolerance. Three other patients had asymptomatic conjunctival hyperemia after 30 months of dipivalyl epinephrine exposure. No patients had conjunctival pigment deposits or cardiovascular side effects. The exfoliative cytology of two patients was characterized by karyomegaly of the conjunctival epithelial cells.

Transscleral neodymium:YAG thermal cyclophotocoagulation in refractory glaucoma. A preliminary report.

Thirty patients treated with transscleral neodymium:YAG laser cyclophotocoagulation (TSYLC) are reported. All patients had advanced glaucoma and had previously undergone one or more surgical procedures that failed, or were unsuitable for surgery. The average preoperative intraocular pressure (IOP) for the group was 43 +/- 12 mmHg. The average follow-up time was 6 months. The average energy level used was 3.8 J (range, 3.5-4.5 J). The patients were divided into two groups. Group 1 consisted of 20 patients in whom laser lesions were applied 3 mm from the limbus. Group 2 consisted of ten patients in whom laser lesions were applied 2 mm from the limbus. Success was defined as an IOP between 22 and 5 mmHg, regardless of the number of treatments required. The overall success rate was 86%. However, group 2 required significantly more retreatment than did group 1. Complications were moderate and transient.

Ocular hypotensive efficacy of 0.25% levobunolol instilled once daily.

The authors evaluated the efficacy of once-daily treatment with levobunolol in patients with primary open-angle glaucoma or ocular hypertension in an open-labeled, two-phase titration clinical trial. All patients started the study using 0.25% levobunolol administered once daily for 3 months (phase I). If a patient's intraocular pressure (IOP) was not controlled with this concentration of levobunolol, the concentration was increased to 0.5% administered once daily for 3 months (phase II). During phase I, a significant reduction in IOP was observed in 21 of the 29 patients (72%), with an average IOP reduction of 24%. During phase II, in six patients whose IOP was reduced inadequately with 0.25% levobunolol, one had a significant reduction in IOP with 0.5% levobunolol. The authors concluded that levobunolol, instilled once daily at a concentration of 0.25%, was effective in significantly reducing IOP in the majority of the patients evaluated.

Treatment of glaucoma with 3 alpha, 5 beta-tetrahydrocortisol: a new therapeutic modality.

The effectiveness of 3 alpha, 5 beta-tetrahydrocortisol (3 alpha, 5 beta-THF), a metabolite of cortisol, in lowering intraocular pressure (IOP) in rabbits made ocular hypertensive with glucocorticoids suggested its use in patients with Primary Open Angle Glaucoma (POAG). Patients with well-documented POAG were treated with a 1% suspension of 3 alpha, 5 beta-THF administered to one eye four times daily for up to six weeks. Eight out of nine patients experienced an appreciable decrease in IOP in the treated eye (average decrease 4.9 mm Hg). There was no conjunctival irritation, corneal pathology, visual field changes, alteration in liver or renal function tests or blood count during the treatment period. The present study demonstrates that 3 alpha, 5 beta-THF, a naturally occurring steroid metabolite, is effective in lowering IOP in patients with POAG. Antiglucocorticoids may represent a new therapeutic modality for the management of POAG.

Decreased 3 alpha-hydroxysteroid dehydrogenase activity in peripheral blood lymphocytes from patients with primary open angle glaucoma.

The purpose of the present study was to determine whether peripheral blood lymphocytes (PBL) from primary open angle glaucoma (POAG) patients have reduced 3 alpha-hydroxysteroid dehydrogenase (3 alpha-HSD) activity as was previously found in POAG-derived cultured trabecular meshwork cells. The availability of PBL from both POAG and control patients makes this a useful system for studying the association of decreased 3 alpha-HSD activity with POAG. PBL were isolated from the venous blood of 17 POAG patients and 22 non-glaucoma controls and assayed for 3 alpha-HSD activity with tritiated 5 beta-dihydrocortisol as a substrate. The mean 3 alpha-HSD activity +/- S.E.M., expressed in comparable units of specific activity, of the POAG derived PBL was 13.8 +/- 1.3 U as compared to 32.8 +/- 2.0 U for control cells. This reduction (> 50%) was statistically significant (P < 0.001). Quantitative immunoblot analysis of PBL indicated that the POAG and control cells, despite their difference in 3 alpha-HSD activity, had nearly identical amounts of 3 alpha-HSD protein. The molecular weight of PBL 3 alpha-HSD from both groups of patients was 38,000, the same as previously reported for human liver. The results of this study show an association of decreased PBL 3 alpha-HSD activity and POAG which was not related to antiglaucoma therapy. The reduced levels of 3 alpha-HSD activity in the readily obtainable PBL may serve as a marker for POAG or those at risk for developing the disease.