Contralateral intraocular pressure lowering effect of prostaglandin analogues

Background:

Though the use of prostaglandin analogues (PGA) for reduction of intraocular pressure (IOP) has shown a marked increase, studies evaluating the contralateral effects of PGA are limited.

Aims:

To evaluate if PGA treatment in one eye has an effect on the IOP of the untreated fellow eye.

Design:

Retrospective study.

Materials and Methods:

Thirty patients of open-angle glaucoma with no previous antiglaucoma treatment underwent 24-hour diurnal IOP phasing. They subsequently were started on a uniocular trial with PGA, and had office diurnal IOP measurements 6 weeks later. Twenty-four hour diurnal consisted of 8 IOP readings over 24 hours and office diurnal consisted of 4 IOP readings between 8 AM and 6 PM at 3 hourly intervals.

Statistical Analysis:

IOPs of the fellow eye during the office diurnal were compared with IOPs at similar time points during the 24-hour diurnal using paired t-tests.

Results:

Mean (± standard deviation) IOP in the treated eye reduced (P < 0.001) from 17.17 ± 3.2 mm Hg at baseline to 13.7 ± 2.4 mm Hg at 6 weeks, while that in the untreated eye reduced from 16.4 ± 3.1 mm Hg to 14.8 ± 2.7 mm Hg (P = 0.01). The decrease in IOP in the untreated fellow eye was statistically significant at 8 AM (2.7 mm Hg, P = 0.003) and 11 AM (2.3 mm Hg, P = 0.01) but not so at 2 PM (1.2 mm Hg, P = 0.10) and 5 PM (0.9 mm Hg, P = 0.19). The amount of IOP reduction in the untreated eye was significantly associated with the magnitude of IOP reduction in the treated eye (β = 0.69, P = 0.008).

Conclusion:

Uniocular PGA treatment tends to reduce the IOP of the untreated fellow eye.     

前列腺素衍生物类药物降眼压的作用机制

病理性眼压升高是青光眼主要的危险因素,目前针对青光眼的手术及药物治疗都旨在降低眼压.前列腺素衍生物因具有降眼压作用而成为治疗青光眼的首选药物.现有的研究表明,前列腺素衍生物类药物主要是通过增加房水从葡萄膜巩膜通道外流来降低眼压的,最新的研究发现贝美前列腺素还可以通过增加房水从小梁网通道外流来降低眼压.目前关于前列腺素衍生物类药物降眼压作用机制仍然在不断地了解、观察、研究中.     

Travoprost compared with other prostaglandin analogues or timolol in patients with open-angle glaucoma or ocular hypertension: meta-analysis of randomized controlled trials

BACKGROUND: It is still uncertain whether travoprost has comparable or better efficacy compared with other prostaglandin analogues or timolol in patients with open-angle glaucoma or ocular hypertension. The authors performed a meta-analysis of randomized controlled trials to evaluate the incidence of reported side-effects and intraocular pressure (IOP)-lowering effect of travoprost versus other prostaglandin analogues (latanaprost, bimatoprost, unoprostone) or timolol. METHODS: Systematic literature retrieval was conducted in Pubmed, EMBASE, Chinese Bio-medicine Database and Cochrane Controlled Trials Register to identify the potentially relevant randomized controlled trials. The statistical analysis was performed by RevMan 4.1 software that was provided by the Cochrane Collaboration. The outcome measures were the incidence of reported side-effects (hyperaemia, iris pigmentation, eyelash changes) and mean IOP pooled over treatment visits. RESULTS: In total, 12 articles involving 3048 patients with open-angle glaucoma or ocular hypertension were included in this meta-analysis. The combined results showed that travoprost 0.004% was more effective than timolol or travoprost 0.0015% in lowering IOP, but not more effective than bimatoprost or latanoprost. Travoprost 0.004% caused a higher percentage of hyperaemia than timolol, latanoprost, or travoprost 0.0015%. There was an increased incidence of pigmentation with travoprost than timolol. Travoprost 0.004% caused a higher percentage of eyelash changes than timolol, latanoprost, or travoprost 0.0015%. CONCLUSION: According to data available, travoprost is more effective than timolol in lowering IOP in patients with open-angle glaucoma or ocular hypertension. Compared with other prostaglandin analogues, travoprost appears to be equivalent to bimatoprost and latanoprost. Although a limited number of local side-effects were reported, no serious treatment-related side-effects were reported.     

The influence of central corneal thickness on response to topical prostaglandin analogue therapy

ObjectiveCentral corneal thickness (CCT) affects intraocular pressure (IOP) readings; however, CCT influence on topical medication efficacy is unknown. We evaluated the IOP-lowering effect of topical prostaglandin analogues (PGAs) in relation to CCT.DesignPost hoc analysis of a randomized prospective trial.MethodSubjects randomized to a PGA were followed for 24 weeks and were analyzed for relationship between CCT and IOP lowering.ParticipantsPatients with either newly diagnosed ocular hypertension or open-angle glaucoma.Results75 subjects were enrolled. The mean age was 62.7 ± 10.5 years; 48 were Caucasian. The mean CCT was 562.4 ± 41.4 μ. At repeated measures, ANCOVA analysis showed a significant effect of both baseline IOP (p < 0.0001) and CCT (p = 0.003) on IOP. At week 12, a regression analysis of the effect of CCT on baseline IOP showed that for every 10 μ increase in CCT there was 0.3 mm Hg less IOP decrease from baseline.ConclusionsWe found a statistically significantly association between a lower mean IOP and a thinner cornea when baseline IOP is controlled for. The magnitude of the relationship is small but may be clinically significant in patients with either very thin or very thick corneas.     

A rare ocular complication of mumps: kerato-uveitis

PURPOSE: To report a child who developed kerato-uveitis associated with mumps infection. METHODS: A prospective study of a child who was observed at the Department of Ophthalmology, Marmara University, Faculty of Medicine, during spring 2003. RESULTS: An 11-year-old male patient noticed decreased vision in his left eye. His right eye was completely normal. Visual acuity was perception of hand movements in the left eye. Ocular examination revealed ciliary injection and diffuse hyperemia of the conjunctiva, interstitial keratitis characterized by prominent stromal infiltrates and edema, folds in the Descemet's membrane, and microcystic epithelial edema in his left eye. The patient had been diagnosed as having mumps 10 days previously by a pediatrician. Complete recovery of the keratitis occurred on the 10th day of topical steroid treatment. CONCLUSIONS: Keratitis and/or iritis are rare complications of mumps. Corneal involvement is characterized by unilateral and painless interstitial keratitis that may cause a significant decrease in vision. Keratitis resolves with treatment and does not have any sequelae.     

Central Serous Chorioretinopathy Associated with Topical Latanoprost Therapy

Purpose: To report a case of central serous chorioretinopathy (CSC) as a possible complication of latanoprost treatment.

Methods: A 65-year-old woman presented with a 1-week history of blurred vision and metamorphopsia in her right eye. She was previously diagnosed with unilateral glaucoma, and treatment was initiated with topical latanoprost 0.005% for the right eye. The symptoms occurred 1 month after initiation of glaucoma treatment.

Results: Visual acuity (VA) of the patient had reduced to 20/50 in right eye. Fluorescein angiography revealed a focal RPE leak near to the fovea with neurosensory detachment due to CSC, which was confirmed by optical coherence tomography. After cessation of the therapy, her clinical and morphological status improved spontaneously. The neurosensory detachment resolved almost completely and VA improved to 20/20 simultaneously.

Conclusions: The authors report the first case of CSC associated with latonoprost therapy. This case demonstrates that topical latanoprost may lead to the development of CSC.     

Purtscher-like retinopathy: A rare complication of peribulbar anesthesia

Purtscher and Purtscher-like retinopathy is a distinctive retinal syndrome characterized by ischemic retinal whitening in a peripapillary pattern. We report a case of Purtscher-like retinopathy in a healthy 64-year-old man after a routine peribulbar anesthetic injection for cataract surgery. Although peribulbar anesthesia is considered to be a safer alternative to retrobulbar anesthesia, it has been associated with unusual but grave complications including central retinal artery occlusion.     

Macular tractional retinal detachment: A rare complication of blunt trauma

Traumatic rhegmatogenous retinal detachment after blunt ocular trauma is a known entity. A tractional macular detachment occurring posttrauma without a retinal break is a unique presentation. A 25-year-old gentleman after blunt ocular trauma with a ball presented a week later with a vision of 20/800, large subretinal bleed and resolving vitreous hemorrhage in the right eye. Three weeks later, an extensive glial proliferation at the posterior pole and macular tractional retinal detachment was noted with the worsening of visual acuity. A vitrectomy, membrane peeling, and silicone oil tamponade with a subsequent silicone oil removal at 6 months stabilized the macula, and vision improved to 20/120. A tractional macular detachment post blunt trauma is rare albeit an interesting occurrence, which can be effectively managed with vitrectomy and allied procedures.     

Evaluating the visual experience: visual acuity and the visual analogue scale

PURPOSE: To attempt a comparison of the visual experience [assessed using a visual analogue scale (VAS)] with visual acuity in a group of normally-sighted adult optometric patients. METHODS: A single-item 100 mm paper VAS was administered to a sequence of 142 normally-sighted pre-presbyopic patients. Each individual was invited to indicate their recent subjective distance visual experience between the extremes of 'dreadful' (0 mm) and 'perfect' (100 mm). Each patient's binocular visual acuity was then determined at 6 m using a high-contrast logMAR chart under usual consulting room conditions. RESULTS: A weak association was revealed between the subjective indication of recent visual experience and the actual level of binocular acuity recorded in this normally-sighted group of subjects. On the basis of group responses a statistically significant discontinuity in the scores recorded with the VAS was demonstrated between patients who attained a clinical acuity better or worse than 0.10 logMAR units (6/7.5). Patient gender, age, and whether spectacles were habitually worn for distance viewing, were each revealed to be not statistically significant features. CONCLUSIONS: For normally-sighted optometric patients the subjective criterion of visual satisfaction would appear to be only loosely associated with the contemporaneous record of clinical acuity.     

Comparison between isopropyl unoprostone and latanoprost by prostaglandin E(2)induction, affinity to prostaglandin transporter, and intraocular metabolism

The pharmacological differences between isopropyl unoprostone (referred to as unoprostone) and latanoprost, concerning their induction of endogenous prostaglandin E(2)(PGE(2)) and affinity to a human prostaglandin transporter (PGT), were investigated.Freshly dissected bovine iris tissues were incubated with major intraocular metabolites of unoprostone, M1 and M2, acid of latanoprost, or PGF(2 alpha), and PGE(2)induction was measured. Affinities of M1, M2, latanoprost, acid of latanoprost, and PGF(2 alpha)to PGT molecule were measured using PGT-cDNA transfected HeLa cells by an isotopic influx assay.(3)H-unoprostone was incubated with freshly prepared serum, aqueous humor, or frozen stored fetal bovine serum (FBS), and the radioactivity of supernatants was measured to investigate their metabolism of(3)H-unoprostone.M2, acid of latanoprost, and PGF(2 alpha)significantly increased a release of PGE(2)compared with the control. 10 microM indomethacin completely inhibited PGE(2)induction by acid of latanoprost and PGF(2 alpha), while 100 microM indomethacin was required to inhibit PGE(2)induction completely by M1 and M2. Unoprostone, M1, M2, and latanoprost showed little affinity to PGT, while acid of latanoprost had an affinity to PGT. Freshly prepared serum and aqueous humor metabolized unoprostone, but frozen stored FBS did not. The release of endogenous PGE(2)may play an important role of action by means of PG analogs, and differences in indomethacin-related inhibition of PGE(2)release and in affinities to PGT may in part cause their different actions.     

糖尿病性白内障术后并发症

目的 分析糖尿病性白内障行小切口非超声乳化白内障摘出联合人工晶状体植入术后的并发症。方法对206例（206眼）糖尿病性白内障行小切口非超声乳化白内障摘出联合人工晶状体植入进行临床观察其并发症。结果糖尿病性白内障术后并发症显著比对照组多。结论糖尿病性白内障术后并发症较多。手术前后控制血糖至关重要。     

A rare complication after transcanalicular dacryocystorhinostomy: tissue necrosis and nasal-cutaneous fistula

Transcanalicular dacryocystorhinostomy (TCDCR) with diode laser is a minimally invasive technique with good cosmetic results. The reported complication rate is low. In this brief report, the authors describe a patient with tissue necrosis and nasal-cutaneous fistula after TCDCR. A 65-year-old woman attended the authors' clinic 1 month after TCDCR. Examination revealed a large tissue defect and nasal-cutaneous fistula in the medial canthal region. Aspergillus growth was noted in culture specimens taken from the nasal cavity. The patient was treated with intravenous amphotericin B. The treatment resulted in granulation and closure of the defect.     

Long-term assessment of prostaglandin analogs and timolol fixed combinations vs prostaglandin analogs monotherapy

AIM: To draw a Meta-analysis over the comparison of the intraocular pressure (IOP)-lowering efficacy and safety between the commonly used fixed-combinations of prostaglandin analogs and 0.5% timolol with prostaglandin analogs (PGAs) monotherapy. METHODS: After searching the published reports from MEDLINE, EMBASE, the Cochrane Library, all randomized controlled clinical trials (RCTs) comparing the fixed combination of PGAs/timolol therapy (FCs) and PGAs monotherapy with treatment duration at least 6mo were included. The efficacy outcomes were mean diurnal IOP, percentage of participants whose IOP were lower than 18 mm Hg, incidence of visual field change, while the safety outcomes included corneal side effects, hyperemia and eye irritation. The analysis was carried out in RevMan version 5.3 software. RESULTS: After six-month medical intervention, the mean diurnal IOP of FCs was lower than PGAs (MD -1.14, 95% CI -1.82 to -0.46, P=0.001); the percentage of target IOP achieving between FCs and PGAs showed no significant difference (RR 1.18, 95% CI 0.97 to 1.43, P=0.10). No statistically significant differences of the incidence of hyperemia (RR 0.67, 95% CI 0.45 to 1.01, P=0.06) and eye irritation (RR 1.20, 95% CI 0.95 to 1.51, P=0.12) between the FCs and PGAs monotherapy were detected. Only one research involved in corneal events, result of this trial revealed no difference between two intervention groups regarding corneal effects (central endothelial cell density, MD -0.20, 95% CI -0.72 to 0.32, P=0.45; central corneal thickness, MD -0.01, 95% CI -0.02 to 0.00, P=0.23). The evaluation of visual field change was not performed due to the limited duration of the trials included in this Meta-analysis. CONCLUSION: The long-term efficacy of the FCs overweighed the PGAs monotherapy in lowering IOP, but in the incidence of hyperemia and eye irritation syndromes, the differences are not statically significant. More RCTs with detailed and authentic data over the assessments of visual functions and morphology of optic nerve heads are hoped to be conducted.     

Synthesis of cyclooxygenase products by human anterior uvea from cyclic prostaglandin endoperoxide (PGH2)

The ability of human anterior uvea to synthesize cyclooxygenase products like thromboxane-A₂ (TxA₂), prostaglandin (PG) I₂, E₂ and D₂ was assessed by using radiometric chromatography and bioassay techniques. Incubation of cyclic PC endoperoxides with indomethacin-treated human anterior uvea (IHIM) produced TxA₂-like activity. IHIM, when either pretreated with imidazole, a TxA₂ synthetase inhibitor, or boiled, failed to generate TxA₂-like activity, indicating an enzymatic nature of the endoperoxide transformation. In addition, bioassay with rabbit aorta and dog coronary artery demonstrated that human anterior uvea not only synthesizes TxA₂-like but also PGI₂-like activities. Other evidence that human anterior uvea is capable of generating PGI₂ came from studies on the extraction and subsequent stability of the substance formed from PGH₂ following incubation with IHIM. Radiometric chromatography further confirmed the generation of 6-keto-PGF_1α (PGI₂ end product) which was inhibited by tranylcypromine (a PGI₂ synthetase inhibitor). Human anterior uvea also synthetized PGF_2α, PGE₂ and PGD₂ from ¹⁴C-PGH₂. Boiled anterior uvea failed to generate these cyclooxygenase products from [¹⁴C]PGH₂ indicating that the synthesis of TxA₂, PGI₂, E₂, F_2α and D₂ was enzynatic in nature.