Comparison of intraocular pressure peak and fluctuations among Filipino patients with non-glaucomatous eyes and glaucoma suspects using water drinking test and diurnal intraocular pressure

AIM: To compare the intraocular pressure (IOP) peaks and fluctuations using water drinking tests (WDTs) and mean diurnal IOP among Filipino patients with normal eyes and glaucoma suspects METHODS: This prospective study included normal and glaucoma suspect patients. Each patient underwent both WDT and mean diurnal examination on separate visits. For mean diurnal examination, IOP was recorded every 2h for 8h while in WDT, IOP was recorded prior to WDT, and post-WDT at 5, 15, 30, 45, and 60min. IOP peak was recorded as the highest IOP for both methods, and IOP fluctuation was recorded as highest IOP minus lowest IOP. RESULTS: With the comparison of diagnostic tests, both normal eyes and glaucoma suspect groups, the peak IOP was caught at 15min. Comparative analysis of both groups also showed that the peak IOP measurements were statistically higher for the WDT compared to mean diurnal IOP (P=0.039, P=0.048 under normal group and P=0.032 and P=0.031 under glaucoma suspect group). Similarly, the WDT had a statistically higher mean IOP fluctuation score than the mean diurnal IOP method in both groups (P=0.003, P=0.011 under normal group; P=0.002 and P=0.005 under glaucoma suspect group). CONCLUSION: This study shows that WDT is a comparable diagnostic exam in predicting IOP fluctuations than mean diurnal measurement. WDT is a promising diagnostic procedure for risk assessment in glaucoma.

Efficacy and safety of newly developed preservative-free latanoprost 0.005% eye drops versus preserved latanoprost 0.005% in open angle glaucoma and ocular hypertension: 12-week results of a randomized, multicenter, controlled phase III trial

AIM: To evaluate the therapeutic efficacy, safety and tolerability of newly developed preservative-free (PF) latanoprost generic [TJO-002] and compare it with benzalkonium chloride (BAK)-preserved latanoprost [Xalatan®] in patients with primary open angle glaucoma (POAG) and ocular hypertension (OHT). METHODS: Included patients were aged ≥19y with POAG/OHT. After a washout period, patients with IOP 21-35 mm Hg at 9 a.m. were enrolled. After a full ophthalmic and glaucoma examination, 144 patients with POAG and OHT participated in this study. Subjects were randomly assigned either PF latanoprost (74 eyes) or BAK-preserved latanoprost (70 eyes). All subjects were examined at 4, 8, and 12wk after first administration. At each follow-up visit, IOP was measured at 9 a.m. and 5 p.m. and compliance was assessed. Throughout the study, all adverse events were recorded and monitored by the masked investigators who measured IOP. RESULTS: Both groups showed a statistically significant decrease of average diurnal IOP at 12wk compared to baseline (-7.21±3.10 mm Hg in the PF latanoprost group and -7.02±3.17 mm Hg in the BAK latanoprost group, both P<0.0001). There was no statistically significant diurnal IOP variation between the groups. In terms of tolerability, pruritus, burning/stinging, and sticky eye sensation, severity was significantly lower in the PF latanoprost group than in the BAK latanoprost group (P<0.05). CONCLUSION: PF latanoprost has at least similar efficacy in terms of IOP reduction and better tolerability compared with BAK latanoprost.

Short- and long-term agreement and reproducibility of 48-hours intraocular pressure measurements in glaucoma patients

Background Glaucomatous eyes often show strong intraocular pressure (IOP) fluctuations and individual measurements at different time points are necessary for personalized therapy. To survey IOP variations 48-hours diurnal and nocturnal IOP measurements were performed on two consecutive days. Aims of this study were to investigate the short-term repeatability of 48-hours measurements within one patient’s IOP profile and long-term repeatability between two separate IOP profiles of the same patient. Methods A retrospective cohort study was performed evaluating data of 90 glaucoma patients in a German university medical center between 2006 and 2013. All patients underwent two separate diurnal IOP profiles of 48 h. IOP was measured at 8 am, 2 pm, 6 pm, 9 pm using Goldmann applanation tonometry and at 12 midnight using Perkins tonometry in supine position on two consecutive days. Intraclass correlation coefficients (ICC) were calculated to evaluate agreement for the same time points (each time point agreement) and for consecutive measurements within the IOP profiles (between time point agreement). ICC ≤ 0.4 was defined as poor agreement, 0.4–0.75 as moderate and ≥ 0.75 as excellent. Differences between time points were investigated by Bland Altman plots. Results Each time point measurements of profile 1 showed moderate to excellent agreement (ICCs 0.62–0.93). There was a moderate to excellent agreement for measurements between time points of profile 1 (ICCs day one 0.57–0.86, day two 0.71–0.90). Profile 2 was performed at a median interval of 12.0 months (quartiles 11.0 to 21.0). Each time point agreements within profile 2 showed ICCs from 0.23 to 0.81. It showed moderate to excellent agreement for changes between time points (ICCs 0.53–0.94). Day two demonstrated ICCs from 0.74 to 0.88. Long term IOP repeatability (over both pressure profiles) showed moderate to good agreement (ICCs 0.39–0.67). Conclusions Short and long-term agreement of IOP measurements evaluated by diurnal IOP profiles is moderate to good. Due to mostly moderate agreements, which we believe represent IOP fluctuations, we conclude that it is necessary to perform 48-hours IOP profiles to gain a better overview of the individual IOP fluctuations.

Two-year outcomes of the MINIject drainage system for uncontrolled glaucoma from the STAR-I first-in-human trial

Background/AimsThe current study evaluates the efficacy and safety of the stand-alone implantation of the MINIject (iSTAR Medical, Wavre, Belgium) supraciliary, microinvasive glaucoma drainage device in patients with medically uncontrolled open-angle glaucoma.MethodsThis prospective, multicentre, first-in-human, single-arm interventional study evaluated stand-alone, ab interno implantation in 25 patients of a 5 mm long uveoscleral device made of STAR biocompatible material, which is a soft, microporous, flexible silicone. The primary outcome was the reduction of intraocular pressure (IOP) at 6 months compared with baseline, and follow-up continued until 2 years for 21 patients. Secondary outcomes included success defined as diurnal IOP of ≤21 mmHg and >5 mmHg with an IOP reduction of 20% without (complete) or with/without (qualified) glaucoma medication.ResultsMean baseline IOP was 23.2±2.9 mmHg on 2.0±1.1 glaucoma medication ingredients and decreased to 13.8±3.5 mmHg (−40.7% reduction) on 1.0±1.3 medications 2 years after implantation. Complete success was achieved in 47.6% of patients (10/21) and qualified success in 100% of patients (21/21) at the 2-year follow-up. All patients achieved a 20% IOP reduction with 48% of patients medication-free. No serious ocular adverse events or additional glaucoma surgery were reported. Mean central endothelial cell density (ECD) mildly decreased from 2411 cells/mm2 (n=26) to 2341 cells/mm2 (n=21) at 24 months, which represents a 5% decrease for matched eyes. No patient had a ≥30% decrease in central ECD.ConclusionThis first-in-human study on the stand-alone implantation of the MINIject supraciliary drainage system shows promising IOP-lowering results and medication reduction over 24 months with few adverse events.Trial registration numberNCT03193736.

Risk factors for disease progression in low-teens normal-tension glaucoma

Background/AimsTo investigate the risk factors for disease progression of normal-tension glaucoma (NTG) with pretreatment intraocular pressure (IOP) in the low-teens.MethodsOne-hundred and two (102) eyes of 102 patients with NTG with pretreatment IOP≤12 mm Hg who had been followed up for more than 60 months were retrospectively enrolled. Patients were divided into progressor and non-progressor groups according to visual field (VF) progression as correlated with change of optic disc or retinal nerve fibre layer defect. Baseline demographic and clinical characteristics including diurnal IOP and 24 hours blood pressure (BP) were compared between the two groups. The Cox proportional hazards model was used to identify the risk factors for disease progression.ResultsThirty-six patients (35.3%) were classified as progressors and 66 (64.7%) as non-progressors. Between the two groups, no significant differences were found in the follow-up periods (8.7±3.4 vs 7.7±3.2 years; p=0.138), baseline VF mean deviation (−4.50±5.65 vs −3.56±4.30 dB; p=0.348) or pretreatment IOP (11.34±1.21 vs 11.17±1.06 mm Hg; p=0.121). The multivariate Cox proportional hazards model indicated that greater diurnal IOP at baseline (HR=1.609; p=0.004), greater fluctuation of diastolic BP (DBP; HR=1.058; p=0.002) and presence of optic disc haemorrhage during follow-up (DH; HR=3.664; p=0.001) were risk factors for glaucoma progression.ConclusionIn the low-teens NTG eyes, 35.3% showed glaucoma progression during the average 8.7 years of follow-up. Fluctuation of DBP and diurnal IOP as well as DH were significantly associated with greater probability of disease progression.

Impact of diurnal IOP variations on the dynamic corneal hysteresis measured with air-puff swept-source OCT

The deformation amplitudes measured with air-puff OCT are sensitive to both (intraocular pressure) IOP and biomechanical properties of the cornea. Analysis of the amplitudes of corneal deformation is challenging due to interrelation of IOP and corneal biomechanics. In this study, we used natural diurnal IOP fluctuations to investigate corneal deformations in a number of subjects whose eyes were measured multiple times during a day. The results of analysis, based on corneal hysteresis, revealed a corneal hysteresis parameter, which remains constant during a day for each individual eye. We hypothesize that above-mentioned metric might correlate with biomechanical properties of the cornea without influence of IOP. Full Text: PDF ReferencesMeek KM, Tuft SJ, Huang Y, Gill PS, Hayes S, Newton RH, Bron AJ, "Changes in Collagen Orientation and Distribution in Keratoconus Corneas", Invest Ophthalmol Vis Sci, 2005. 46(6): p. 1948-56. CrossRef Zimmermann DR, Fisher RW, Winterhalter KH, Witmer R, Vaughan L, "Comparative studies of collagens in normal and keratoconus corneas", Exp Eye Res, 1988. 46(3): p. 431-42. CrossRef Andreassen TT, Simonsen AH, and Oxlund H, "Biomechanical properties of keratoconus and normal corneas", Experimental Eye Research, 1980. 31(4): p. 435-441. CrossRef Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M, "Reduction of Intraocular Pressure and Glaucoma Progression", Arch Ophthalmol, 2002. 120(10): p. 1268-79. CrossRef Chauhan BC and Drance SM, "The influence of intraocular pressure on visual field damage in patients with normal-tension and high-tension glaucoma", Investigative Ophthalmology & Visual Science, 1990. 31(11): p. 2367-2372. DirectLink Gelaw Y, "The impact of central corneal thickness on intraocular pressure among Ethiopian glaucoma patients: a cross-sectional study", BMC Ophthalmology, 2012. 12(1): p. 58. CrossRef Doughty MJ and Zaman ML, "Human Corneal Thickness and Its Impact on Intraocular Pressure Measures: A Review and Meta-analysis Approach", Surv Ophthalmol, 2000. 44(5): p. 367-408. CrossRef Liu J, and Roberts CJ, "Influence of corneal biomechanical properties on intraocular pressure measurement: Quantitative analysis", J Cataract Refract Surg, 2005. 31(1): p. 146-55. CrossRef Ehlers N, Hansen FK, and Aasved H, "Biometric Correlations of Corneal Thickness", Acta Ophthalmol (Copenh), 1975. 53(4): p. 652-9. CrossRef Harada Y, Hirose N, Tawara A, "The Influence of Central Corneal Thickness and Corneal Curvature Radius on The Intraocular Pressure as Measured By Different Tonometers: Noncontact and Goldmann Applanation Tonometers", J Glaucoma, 2008. 17(8): p. 619-25. CrossRef Alonso-Caneiro D, Karnowski K, Kaluzny BJ, Kowalczyk A, Wojtkowski M, "Assessment of corneal dynamics with high-speed swept source Optical Coherence Tomography combined with an air puff system", Optics Express, 2011. 19(15): p. 14188-14199. CrossRef Dorronsoro C, Pascual D, Perez-Merino P, Kling S and Marcos S, "Dynamic OCT measurement of corneal deformation by an air puff in normal and cross-linked corneas", Biomedical Optics Express, 2012. 3(3): p. 473-487. CrossRef Karnowski K, Kaluzny BJ, Szkulmowski M, Gora M, Wojtkowski M, "Corneal topography with high-speed swept source OCT in clinical examination", Biomedical Optics Express, 2011. 2(9): p. 2709-2720. CrossRef A. N. S. Institute, "American National Standard for Safe use of Lasers," (American National Standards Institute, Orlando, FL, 2000) DirectLink David R, Zangwill L, Briscoe D, Dagan M, Yagev R, Yassur Y, "Diurnal intraocular pressure variations: an analysis of 690 diurnal curves", Br J Ophthamlom, 1992, 76(5): p. 280-282 CrossRef Maczynska E, Karnowski K, Szulzycki K, Malinowska M, Dolezyczek H, Cichanski A, Wojtkowski M, Kaluzny BJ, Grulkowski I, Journal of Biophotonics (to be published).

The Influence of a Vitrectomy on the Diurnal Intraocular Pressure

Purpose. To evaluate the diurnal intraocular pressure (IOP) in eyes after vitrectomy compared to that of healthy eyes.Methods. Twenty-one patients who had undergone vitrectomy and 21 age- and gender-matched normal controls were enrolled during the same period. We measured the diurnal IOP every two hours between 9 a.m. and 11 p.m. in all patients who were admitted for cataract surgery. Patients with a history of eye surgery (not including vitrectomy) or use of a medication that is associated with IOP were excluded. The IOP and ocular parameters of patients were compared with the same patients’ fellow healthy eyes and with normal eyes of age- and gender-matched controls.Results. There were no significant differences between vitrectomized eyes and normal fellow eyes with regard to all IOP parameters including the maximum, minimum, and IOP fluctuation values. Diurnal fluctuation of IOP (or the difference between the maximum and minimum IOP) was larger in vitrectomized eyes than it was in age- and gender-matched control eyes.Conclusions. Vitrectomy did not markedly affect the IOP. Although there were no severe complications after vitrectomy, the IOP fluctuation was wider in vitrectomized eyes than it was in normal eyes.

Comparison of the efficacy and safety of fixed combination travoprost/timolol and dorzolamide/timolol in patients with primary open-angle glaucoma and ocular hypertension

Introduction. Combining two medications in one bottle may improve compliance by reducing the time required to administer drops and the frequency of the total number of medication bottles. Objective. To compare the efficacy of reduced intraocular pressure (IOP) and safety of fixed combination travoprost 0.004%/timolol 0.5% vs. fixed combination dorzolamide 2%/timolol 0.5% in patients with primary open-angle glaucoma or ocular hypertension. Methods. Prospective randomized clinical study included 60 patients divided into 2 groups. Follow-up was done at day 14 and 45 and month 3. IOP measurements were taken at each follow-up examination at 8 am, 10 am and 4 pm. Results. Both fixed combinations reduced IOP significantly compared to initial values at all follow-ups (p<0.001). Mean pooled IOP at all visits and time points was slightly lower in the travoprost/timolol group compared with the dorzolamide/timolol group (16.13 mmHg vs. 16.15 mmHg). Mean IOP reduction from baseline ranged from -7.46 mmHg to -9.92 mmHg in the travoprost/timolol group and from -6.93 mmHg to -8.93 mmHg for the dorzolamide/timolol group. Mean (?standard error of the mean) reduction in diurnal IOP from baseline to 3rd month was 8.96?2.79 in the travoprost/timolol group versus 8.07?2.91 in patients receiving dorzolamide/timolol fixed combination (p=0.196). The most frequent treatment-related adverse events were conjunctival hyperemia in the travoprost/timolol group, and dry eye and foreign body sensation in the dorzolamide/timolol group. Conclusion. Travoprost/timolol fixed combination was slightly more effective than dorzolamide/timolol fixed combination in reducing mean diurnal IOP. Travoprost/timolol group resulted in an IOP reduction for up to 1.07 mmHg higher than dorzolamide/timolol group. Both fixed combinations were well tolerated and safe.

A Comparative Analysis of the Efficacy and Safety of fixed Combinations of Latanoprost/Timolol vs Dorzolamide/Timolol in Primary Open Angle Glaucoma or Ocular Hypertension

ABSTRACT Background Glaucoma is a leading cause of irreversible blindness. The fundamental problem in medical management of glaucoma is of patient compliance. An ideal drug or a drug combination is needed to slow the progression of this majorly symptomless disease. Aim To compare the efficacy and tolerability of the fixed combination latanoprost and timolol instilled once daily in the evening vs fixed combination of dorzolamide and timolol instilled twice daily in primary open angle glaucoma or ocular hypertension. Materials and methods A 12-week, randomized, open, parallel group study including 50 patients with primary open angle glaucoma or ocular hypertension was conducted at a tertiary care hospital. Patients were randomized to group 1, (fixed combination (FC) latanoprost and timolol eye drops, once daily in evening) and group 2, (FC dorzolamide and timolol eye drops, twice daily). At baseline, 2, 4 and 12 weeks, IOP was recorded at 9 AM and 12 noon. The difference in IOP reduction in two treatment groups from baseline to 12 weeks was the main outcome measure. Results Mean diurnal IOP was similar at baseline for both groups. Mean reduction in IOP from baseline to 12 weeks was 9.92 mm Hg (p = 0.001) in group 1 and 9.22 (p = 0.001) in group 2. The reduction in IOP in both groups 1 and 2 was statistically significant at all time intervals. There was a statistically significant advantage for group 1 at 12 weeks for both time readings (p = 0.013 and 0.002 respectively) as compared to group 2. Conclusion The fixed combination of latanoprost and timolol was more effective than that of dorzolamide and timolol in reducing mean diurnal IOP and both treatments were well tolerated. To confirm further such studies are required. How to cite this article Ratol S, Walia R, Chaudhry M. A Comparative Analysis of the Efficacy and Safety of fixed Combinations of Latanoprost/Timolol vs Dorzolamide/Timolol in Primary Open Angle Glaucoma or Ocular Hypertension. J Postgrad Med Edu Res 2012;46(4):172-176.