Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety

Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open?angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open?label, real?world, multicentric, observation?based 3?month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first?line therapy. Diurnal IOP measurements, best?corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day?1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty?nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once?daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first?line treatment in primary open?angle glaucoma and ocular hypertension was both safe and effective.

Study of demography and clinical profile of ectopic pregnancies in a tertiary level hospital in Uttarakhand: a five year review

Background: Ectopic pregnancy is a condition when a fertilized ovum is implanted outside the uterine cavity. Life threatening risk of rupture of ectopic pregnancy remains one of the important causes of maternal mortality in India. The aim of study is to analyse the clinical profile, associated risk factors, complications, treatment outcomes to improve maternal mortality and morbidity associated with ectopic pregnancy.Methods: It is a retrospective study conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences from January 2015 to January 2020. A total of 182 patients diagnosed of Ectopic Pregnancy were analysed for clinical profile, risk factors, serology, ultrasound findings, complications, treatment offered and outcome.Results: During the study period of 5 years there were total 182 patients who were diagnosed of ectopic pregnancy showing the incidence of ectopic pregnancy in our hospital 1.4% of total number of deliveries. Majority of patients were in the age group of 25 to 30 years (43.95%). Mostly multiparous women (80.1%) had ectopic pregnancy. Majority of patients (56.1%) had no associated risk factors for ectopic pregnancy. Main presenting complain was abdominal pain in 58.8% of patients. Majority of patients (63.2%) had surgery as primary care which indicates delay in diagnosis and arrival at hospital especially in hilly region of Uttarakhand.Conclusions: Ectopic pregnancies need to be diagnosed timely to decrease maternal morbidities and mortalities.  Clinical signs and symptoms with serology (Serum beta hCG) and radiological findings helps to optimize treatment for potentially life-threatening condition.

Glaucoma: role of neuroprotective agents.

Glaucoma is an optic neuropathy, considered as the second leading cause of blindness worldwide. Glaucoma is characterized by selective death of retinal ganglion cells (RGC) and a progressive loss of vision. Elevated intraocular pressure (IOP) is one of the most important risk factors for developing glaucoma and hence we mainly focus on lowering IOP to arrest the progression of glaucoma. However, many patients continue to demonstrate a clinically downhill course despite the control of initially raised IOP. In fact, some patients develop what is called normal tension glaucoma, not associated to an increased IOP. This emphasizes that several pressure-independent mechanisms are responsible for the development and progression of glaucomatous neuropathy and that high IOP and vascular insufficiency in the optic nerve head are only risk factors for the development of glaucoma, and are not the only target for the treatment of glaucoma. The reason is that the process of RGC death is thought to be biphasic, and the primary injury is followed by a slower secondary degeneration related to a noxious environment surrounding the apoptotic cells. This environment is characterized by changes in the extra-cellular ionic concentrations, increased amounts of free radicals, neurotrophins (NT) depletion and increased glutamate-induced excitotoxicity due to high extra-cellular glutamate levels, which binds to N-methyl-D-aspartate (NMDA) receptors leading to an abnormally high intracellular Ca2+ concentration. Neuroprotection is a process that attempts to preserve the remaining cells that are still vulnerable to damage, and the main aim of neuroprotective therapy is to employ pharmacologic or other means to attenuate the hostility of the environment surrounding the degenerating cells, or to supply the cells with the tools to deal with this aggression, providing resilience to the insult. Several agents have been reported neuroprotective in glaucoma, both in clinical assays, such as Ca2+ channel blockers, and in experimental studies, such as betaxolol, brimonidine, NMDA antagonists, nitric oxide synthase inhibitors, NT and Ginkgo biloba extract. Most neuroprotective agents for glaucoma have proved beneficial effects over RGC, not showing effects over IOP. However, when analyzing classically used medications for glaucoma, it becomes difficult to understand if its effect over the progression of glaucoma is due to neuroprotective pathways or by means of lowering IOP. The ideal anti-glaucoma drug would be one that when applied topically, reduces IOP, but also probes to reach the retina in appropriate amounts, and activates specific receptors in the retina to attenuate RGC death. In this review, we will examine currently advocated neuroprotective drug-based strategies in the potential management of glaucoma.

Modified silicone sling assisted temporalis muscle transfer in the management of lagophthalmos.

Aim: To evaluate the efficacy of modified temporalis muscle transfer (TMT) by silicone sling for the management of paralytic lagophthalmos. Settings and Design: Prospective interventional study. Materials and Methods: Ten patients of lagophthalmos due to facial palsy underwent modified TMT using silicone sling. The patients were followed‑up for a period of 3 months. Palpebral aperture in primary gaze and during eye closure were assessed both pre‑ and postoperatively along with problems associated with lagophthalmos like exposure keratopathy and lacrimation. Statistical Analysis: Paired t‑test was applied to measure the statistical outcome. Results: Eight patients achieved full correction of lagophthalmos with no lid gap on closing the eye. The mean (standard deviation (SD)) lid gap on eye closure was 7.7 (0.86) mm preoperatively, 0.5 (0.47) mm at 1st postoperative day, and 0.7 (0.75) mm at 3rd month. There was a reduction in mean lid gap on eye closure of 7 mm at 3 months (P < 0.0001) which is highly significant. The mean (SD) vertical interpalpebral distance during primary gaze was 12.05 (1.12) mm preoperatively, 10 (0.94) mm at 1st postoperative day, and 10.35 (1.08) mm at 3rd month. There was a reduction in mean vertical inter palpebral distance of 1.7 mm at 3 months (P = 0.001) which is significant. Exposure keratitis decreased in five out of six patients at 3 months. Conclusion: Modified TMT by silicone sling is a useful procedure with lesser morbidity and good outcomes for the treatment of paralytic lagophthalmos due to long standing facial palsy.

A prospective study on the use of magnesium sulfate in prevention and management of eclampsia with emphasis on adverse drug reactions.

Introduction: The hypertensive disorders in pregnancy are the leading causes of maternal and perinatal mortality. Management of preeclampsia and eclampsia remains controversial even today. Several drugs with different regimens are available at present. As a consequence; women are treated in various ways by different regimens. Aim: Our work aimed to study the use of various magnesium sulfate regimens used in management of eclampsia in a tertiary care teaching rural hospital. Methods: A prospective, observational, non-interventional study was carried out among the eclamptic patients admitted to obstetrics ward. After explaining the purpose and method of study, through the patient information sheet, patients willing to sign the informed consent form were enrolled for the study. Relevant data was gathered from their case files and by direct interview with the patients that were recorded in the case record form. Results: Of the 35 cases of eclampsia recorded during the study period, we observed that all the patients were treated with Pritchard’s regimen of Magnesium Sulfate. It was noticed that there was improvement in all the patients with no adverse drug reactions recorded during the time of management. Conclusion: Maternal and perinatal mortality can be reduced to major extent by prevention of eclampsia. Prompt diagnosis and institution of therapy by selecting an ideal anticonvulsant is essential as the maternal and perinatal mortality progressively rises with increase no of convulsions. Magnesium Sulfate is a potent anticonvulsant with mild antihypertensive activity with less adverse effects.