An economic analysis of selective laser trabeculoplasty versus topical prostaglandin analogues as initial therapy for primary open-angle glaucoma in a tertiary government hospital in the Philippines

Objective@# This study compared the economic viability of initial medical therapy with topical prostaglandin analogues (PGAs) versus selective laser trabeculoplasty (SLT) in the treatment of primary open-angle glaucoma (POAG).@*Method@#This was an economic analysis using actual, current treatment costs of PGA therapy versus SLT applied to theoretical, literature-derived clinical efficacy data projected for a period of 19 years. A socioeconomic and demographic survey conducted among POAG patients at the Department of Health Eye Center of the East Avenue Medical Center from March-April 2022 provided the economic context and setting for the analysis. The treatment regimens were compared in terms of total cost, clinical efficacy, cost-effectiveness and cost-utility in the setting of a tertiary government hospital.@*Results@#Thirty-one (31) patients were included in the study. The total annual cost of topical PGAs was Philippine Pesos (Php) 13,532 versus Php 6,195 for SLT. Cost-effectiveness was Php 1,933 for PGAs/mmHg reduction in intraocular pressure (IOP) versus Php 983 for SLT. Cost-utility was Php 59,793/Quality Adjusted Life Years (QALY) gained for PGAs versus Php 27,373/QALY gained for SLT projected for 19 years. With government insurance coverage, cost-utility ratio was Php 47,831/QALY gained for topical PGAs versus 16,327/QALY gained for SLT.@*Conclusion@#In POAG patients, SLT was more cost-effective versus PGAs with a lower cost per mmHg IOP reduction, and lower cost-utility ratio for every QALY gained. SLT can be recommended as initial therapy for POAG especially for patients being treated at tertiary government hospitals.

The role of prostaglandin F2α on ovulation and LH release in cows / A função da prostaglandina F2α na ovulação e na liberação de LH em vacas

This study aimed to evaluate the role of prostaglandin F2α (PGF) on ovulation. In Experiment 1, cows were randomly allocated to two treatments to receive 150 µg of d-Cloprostenol (PGF Group, n = 12) or 2 mL of NaCl 0.9% (Control Group, n = 11) and CIDRs, were removed 4 days later. No cow ovulated in Control and PGF groups. In Experiment 2, cows were randomly separated into two experimental groups to receive 4 injections of 150 µg of d-Cloprostenol (n = 9) or 2 mL of NaCL 0.9% (n = 9). In this experiment, ovulation was not observed in any cows. In Experiment 3, ovariectomized cows receive three injections of 300µg of PGF analog (PGF Group, n = 5), 100µg of Lecirelin (GnRH Group, n = 5) or 2 mL of PBS (Control Group, n = 4). The LH concentration was higher (P <0.0001) in cows from the GnRH group than in the PGF and Control groups. In experiment 4, cows with preovulatory follicles (>11.5 mm) were treated with Saline (Control Group, n = 6); Lecirelin (GnRH Group, n = 7) or Cloprostenol Sodium (PGF Group, n = 6). There was a significant increase in the vascular area of follicles from 0 to 24 h in GnRH and PGF treatments. In conclusion, PGF was not able to induce ovulation in cows with high or low plasma progesterone concentration. Additionally, PGF alone was not able to induce LH release and follicle luteinization, but increased follicular vascularization.(AU)

O objetivo deste estudo foi avaliar o papel da prostaglandina F2α (PGF) na ovulação. No Experimento 1, as vacas foram alocadas aleatoriamente em dois tratamentos para receber 150 µg de d-Cloprostenol (Grupo PGF, n = 12) ou 2 mL de NaCl 0,9% (Grupo Controle, n = 11) e os CIDR, foram removidos 4 dias depois. Nenhuma vaca ovulou nos grupos Controle e PGF. No Experimento 2, as vacas foram separadas aleatoriamente em dois grupos experimentais para receber 4 injeções de 150 µg de d-Cloprostenol (n = 9) ou 2 mL de NaCL 0,9% (n = 9). Não foi observada ovulação em nenhum dos animais deste experimento. No Experimento 3, vacas ovariectomizadas receberam três injeções de 300µg de análogo de PGF (Grupo PGF, n = 5), 100µg de Lecirelina (Grupo GnRH, n = 5) ou 2 mL de PBS (Grupo Controle, n = 4). A concentração de LH foi maior (P <0,0001) nas vacas do grupo GnRH do que nos grupos PGF e Controle. No Experimento 4, vacas com folículos pré-ovulatórios (> 11,5 mm) foram tratadas com solução salina (Grupo Controle, n = 6), Lecirelina (Grupo GnRH, n = 7) ou Cloprostenol Sódico (Grupo PGF, n = 6). Houve um aumento significativo na área vascular dos folículos de 0 a 24h nos tratamentos com GnRH e PGF. Em conclusão, a PGF não foi capaz de induzir ovulação em vacas com alta ou baixa concentração plasmática de progesterona. Além disso, a PGF sozinha não foi capaz de induzir a liberação de LH e a luteinização do folículo, mas aumentou a vascularização folicular.(AU)

Reversal of cupping em glaucoma juvenil tratado com análogo de prostaglandina tópica / Reversal of cupping in juvenile glaucoma treated with topical prostaglandin analogue

Resumo A reversão da escavação é uma entidade rara que se refere à redução da escavação do disco óptico em resposta à diminuição sustentada dos níveis de pressão intra-ocular (PIO), em cerca de 25% da PIO basal. A ocorrência deste fenômeno apenas com o tratamento clínico é pouco relatada na literatura, Este estudo relata um caso de um paciente com glaucoma juvenil, que apresentou à gonioscopia ângulo aberto e tomografia de coerência óptica (OCT) com uma diminuição significativa na camada de fibras nervosas retinianas em ambos os olhos. Após um ano utilizando análogos de prostaglandina tópica e manutenção de níveis baixos de PIO, ocorreu diminuição da escavação do nervo óptico, que foi confirmada pelos padrões topográficos da OCT. O "reversal of cupping" é um sinal da diminuição da tensão ao nível da lâmina crivosa e está provavelmente associada a uma redução do risco para a progressão do glaucoma a longo prazo, sem melhora da função visual.

Abstract Reversal of cupping is a rare entity, characterized by the reduction of optical disc cupping in response to sustained decrease in intraocular pressure (IOP) levels by 25% of the basal IOP. The occurrence of this phenomenon with clinical treatment is rarely reported in the literature. This study reports a case of a patient with juvenile glaucoma with augmented cupping, significant decrease in the retinal nerve fiber layer in both eyes and altered topografic measures in optical coherence tomography (OCT). After one year using topical prostaglandin analog and keeping low IOP levels, a decrease in optic nerve cupping was detected in rethinography, confirmed by the improvement of OCT topographic measures. Reversal of cupping is a sign of decreased tension at the level of the lamina cribosa and is probably associated with a reduced risk for long-term progression of glaucoma without improvement of visual function.

New classes of glaucoma medical treatment

Glaucoma is a progressive degenerative disease of the optic nerve head, characterized by a specific pattern of axonal loss and visual field deterioration. This review aims at introducing the different novel pharmacologic agents for its treatment, as well as their mechanisms. Most glaucoma patients require lifelong care and individualized treatment. Intraocular pressure (IOP), which is regulated by aqueous humor production, outflow via the trabecular meshwork (parasympathomimetics only) and uveoscleral outflow pathways, is currently the only treatable target for glaucoma treatment. Conventional glaucoma medications are categorized as β blockers, α agonists, carbonic anhydrase inhibitors, parasympathomimetics, and prostaglandin analogues. The development of basic research-derived novel classes of pharmacologic agents features novel action mechanisms, which are different from those of conventional medications. New classes of recently approved or clinical trial-tested medications include Rho-kinase inhibitors, nitric oxide donors, adenosine agonists, and prostaglandin analogs targeting E-type prostanoid receptors, etc. Their integration and future development will facilitate the expansion and customization of therapeutic options.

Effects of Preservative on the Meibomian Gland in Glaucoma Patients Treated with Prostaglandin Analogues / 전남의대학술지

This study compared the effect of preservative-containing (PC) and preservative-free (PF) prostaglandin analogue (PGA) formulations on the ocular surface, especially on the meibomian gland (MG) in patients with open-angle glaucoma (OAG). This is a retrospective study of treatment-naïve patients with OAG (n=80) and healthy controls (n=40). OAG patients were randomized into groups using either PC-PGA or PF-PGA for 12 months. All participants underwent ocular surface and MG examinations including their meibum score, meiboscore, and lid margin abnormality score (LAS). Eighty OAG patients were randomized into two groups (n=42 in PC, n=38 in PF). All PGA and control groups showed similar ocular surface and MG parameters at the baseline. Both PC- and PF-PGA groups showed increased meibum scores, meiboscores, and LASs at 12 months compared to the baseline (all p<0.05). At the 12-months visit, PC-PGA group showed severe OSDI, shorter TBUT, greater OSS, and worse MG parameters than those of the other two groups (all p<0.05). In addition, PF-PGA group showed worse meiboscores, meibum scores, and severe OSS scores than those of the control group (all p<0.05). Both PC and PF formulations can cause damage to the MG in patients using PGA. However, PC formulations induced more ocular discomfort, poorer ocular surface, and more severe MG loss compared to PF formulations. Therefore, it would be advisable to use PF formulations in patients with a preexisting or concomitant ocular surface disease or MGD.

The relationship between topical anti-glaucoma medications and the development of lacrimal drainage system obstruction / A relação entre medicamentos tópicos anti-glaucoma e o desenvolvimento de obstrução do sistema de drenagem lacrimal

ABSTRACT Purpose: To evaluate whether any topical anti-glaucoma medications increase the risk of lacrimal drainage system obstruction or whether the presence of preservatives alone is sufficient to generate obstruction. Methods: This nested case-control study compared a group of patients with lacrimal duct obstruction who received topical anti-glaucoma medications to a control group of patients without obstruction. Results: The medical records of 255 patients with glaucoma who consulted the Oculoplastic Section with complaints of watery eyes were reviewed. Among these patients, 59 exhibited lacrimal drainage obstruction. Ninety-four percent of patients with lacrimal drainage obstruction used beta-blockers, and 41% used prostaglandin analogs. A logistic regression model was used to adjust for age, sex, and the use of other medications. No significant differences were observed regarding the topical anti-glaucoma medications used between groups. Conclusion: No single topical anti-glaucoma medication demonstrated a stronger association with the development of lacrimal duct obstruction.

RESUMO Objetivo: Avaliar se algum medicamento tópico anti-glaucoma aumenta o risco de obstrução do sistema de drenagem lacrimal ou se a presença de conservantes é su fi cien te para gerar obstrução. Métodos: Este estudo de caso-controle aninhado comparou um grupo de pacientes com obstrução do ducto lacrimal que receberam medicações tópicas anti-glaucoma contra um grupo controle de pacientes sem obstrução. Resultados: Foram revistos os prontuários de 255 pacientes com glaucoma que consultaram a Seção de Oculoplástica com queixas de olhos lacrimejantes. Dentre esses pacientes, 59 apresentavam obstrução da via lacrimal de drenagem. Noventa e quatro por cento dos pacientes com obstrução usaram betabloqueadores e 41% usaram análogos de prostaglandinas. Um modelo de regressão logística foi utilizado para ajustar a idade, sexo e o uso de outros medicamentos. Não foram observadas diferenças significativas em relação às medicações tópicas anti-glaucoma usadas entre os grupos. Conclusão: Nenhum medicamento anti-glaucoma tópico único demonstrou uma associação mais forte com o desenvolvimento de obstrução do ducto lacrimal.

The Short-Term Effect of Prostaglandin Analog Monotherapy on Corneal Biomechanical Properties in Normal Tension Glaucoma Patients

PURPOSE: To evaluate the effects of short-term prostaglandin analogues treatment on the corneal biomechanics of patients with normal tension glaucoma. METHODS: This study included 52 eyes of 52 patients who were diagnosed with normal tension glaucoma. All patients were divided into two groups; one group (27 eyes) received tafluprost while the other group (25 eyes) received travoprost. Intraocular pressure, Biomechanical properties were measured by using goldmann applanation tonometer, ocular response analyzer before treatment and at 8-week after treatment. RESULTS: The mean decrease in intraocular pressure, Goldmann-correlated IOP (IOPg), corneal-compensated intraocular pressure by using Goldmann applanation tonometer, and Ocular response analyzer were statistically significant in total patients, tafluprost, and travoprost group after using prostaglandin analogues (p < 0.001, p < 0.001, p < 0.001, respectively). Corneal hysteresis showed no statistical differences after treatment in total, tafluprost and travoprost group but corneal resistance factor (CRF) showed statistically significant decrease after using prostaglandin analogues in total, tafluprost, and travoprost group (p < 0.001, p = 0.025, p < 0.001). Upon multivariate analysis, the higher initial IOPg and the lower initial CRF checked, the variation of CRF (CRF in baseline – CRF at 8 weeks) got higher (β = 0.134, p = 0.017). CONCLUSIONS: It is needed to carefully monitor and evaluate the effects of prostaglandin analogues on intraocular pressure associated with initial intraocular pressure and the changes of CRF after prostaglandin treatment in normal tension glaucoma patients. CRF is sensitive factor to short-term changes of intraocular pressure after prostaglandin analogues treatment, and it is required to consider the properties of CRF when we evaluate between progression of glaucoma and corneal biomechanical properties.

In Vivo Effects of Preservative-free and Preserved Prostaglandin Analogs: Mouse Ocular Surface Study

PURPOSE: Chronic use of topical hypotensive agents induces several side effects caused by preservatives. The purpose of this study was to evaluate the effects of prostaglandin analogs with varying concentrations of benzalkonium chloride (BAC), preservative-free (PF), and alternative preservatives on mouse corneal tissue. METHODS: Thirty-five, 8- to 10-week-old female C57BL/6 mice (five mice for each group) were used for this study. To the control group, we applied normal saline, and to each drug-treated group we applied 0.02% BAC, bimatoprost 0.01% (with BAC 0.02%), latanoprost 0.005% (with BAC 0.02%), travoprost 0.004% (with 0.001% polyquad) or tafluprost 0.0015% with/without 0.001% BAC, once a day (9 p.m.) for 4 weeks. Corneal fluorescein staining was evaluated in all groups. After harvest, the corneal tissues were embedded in paraffin and then Hematoxylin-Eosin stain was performed for histopathological examination. Immunofluorescence staining was done against TNF-alpha, IL-6, HLA DR, pJNK, and pAkt. RESULTS: In corneal fluorescein staining, severe punctate epithelial keratitis was seen in the groups of 0.02% BAC, 0.02% BAC containing bimatoprost 0.01% and latanoprost 0.005%. The surface desquamation, irregular surface, loss of cell borders, anisocytosis and stromal shrinkage were observed in the groups of BAC-containing eye drops. Moreover, the groups treated with BAC-containing eye drops have high inflammatory markers, significantly decreased cell viability-related signal, pAkt, and higher apoptosis-inducing signal, pJNK, than the control group. On the other hand, travoprost 0.004% and PF tafluprost 0.0015% have less cellular morphologic changes, lower inflammation, and higher cellular viability than BAC-containing formulations. CONCLUSIONS: Corneal damage, increased inflammation and apoptosis and low cell viability were observed in BAC-containing groups. PF or alternatively preserved glaucoma medications seem to be a reasonable and viable alternative to those preserved with BAC.

Topical Prostaglandin Analogue Drugs Inhibit Adipocyte Differentiation

PURPOSE: To investigate the effects of topical prostaglandin analogue drugs on the differentiation of adipocytes. METHODS: Differentiation of 3T3-L1 preadipocytes was induced with isobutylmethylxanthine, dexamethasone, and insulin. 3T3-L1 cells were exposed to 0.008, 0.08, 0.2 microM of latanoprost and travoprost. Reverse transcription polymerase chain reaction for mRNA expression of lipoprotein lipase and peroxisome proliferator-activated receptor gamma 2 (PPARgamma2), and glycerol-3-phosphate dehydrogenase (G3PDH) assays were performed to examine the effects on early and late differentiation, respectively. Also, glycerol assays were done to evaluate the effect of prostaglandin analogues on lipolysis after differentiation. RESULTS: Both prostaglandin analogues inhibited differentiation of preadipocytes. Topical prostaglandin analogues significantly decreased G3PDH activity, a marker of late differentiation. However, topical prostaglandin analogues did not change mRNA expressions of lipoprotein lipase and PPARgamma2, markers of early differentiation. The activities of the early markers of differentiation were not changed significantly before and after growth arrest. Compared to latanoprost, travoprost decreased G3PDH activity more significantly (p 0.05). CONCLUSIONS: Prostaglandin analogues display an inhibitory effect on the differentiation of adipocytes when the cells start to differentiate especially in the late stage of differentiation. Thus, commercial topical prostaglandin analogues may decrease the fat contents of eyelids.

Ocular surface evaluation in patients treated with a fixed combination of prostaglandin analogues with 0.5% timolol maleate topical monotherapy: a randomized clinical trial

OBJECTIVES: To compare ocular surface changes induced via glaucoma treatment in patients using fixed combinations of prostaglandin analogues (travoprost, latanoprost and bimatoprost) with 0.5% timolol maleate METHODS: A prospective, multicenter, randomized, parallel group, single-blind clinical trial was performed in 33 patients with ocular hypertension or open angle glaucoma who had not been previously treated. The ocular surface was evaluated prior to and three months after treatment, with a daily drop instillation of one of the three medications. The main outcome measurements included the tear film break-up time, Schirmer's test, Lissamine green staining, the Ocular Surface Disease Index questionnaire, impression cytology using HE and PAS and immunocytochemistry for interleukin-6 and HLA-DR. Ensaiosclinicos.gov.br: UTN - U1111-1129-2872 RESULTS: All of the drugs induced a significant reduction in intraocular pressure. Decreases in the Schirmer's test results were observed with all of the drugs. Decreases in tear-film break-up time were noted with travoprost/timolol and latanoprost/timolol. An increase in the Lissamine green score was noted with travoprost/timolol and bimatoprost/timolol. The Ocular Surface Disease Index score increased after treatment in the travoprost/timolol group. Impression cytology revealed a significant difference in cell-to-cell contact in the same group, an increase in cellularity in all of the groups and an increase in the number of goblet cells in all of the groups. The fixed combinations induced an increase in IL-6 expression in the travoprost/timolol group, in which there was also an increase in HLA-DR expression. CONCLUSIONS: All of the fixed combinations induced a significant reduction in intraocular pressure, and the travoprost/timolol group showed increased expression of the inflammatory markers HLA-DR and interleukin-6. All three tested medications resulted in some degree of deterioration in ...

Métodos terapêuticos de maturação cervical / Therapeutic methods for cervical ripening

Métodos de maturação cervical são utilizados há décadas, apresentando mecanismos, efetividade e riscos diversos. Para reconhecer os métodos existentes e delimitar quais possuem os menores riscos, melhor efetividade e disponibilidade na prática médica, foi realizada uma revisão crítica, que buscou artigos nas bases Medline/Pubmed, biblioteca Cochrane e LILACS/SciELO, referentes à maturação cervical mecânica ou farmacológica em gestantes com termos e palavras-chave relacionadas à maturidade cervical, misoprostol e parto induzido. Constatou-se que os métodos mais utilizados na prática são a prostaglandina sintética (misoprostol) e a sonda de Foley. Estes se mostraram superiores aos demais métodos encontrados, uma vez que são efetivos, têm baixo custo, são fáceis de armazenar e utilizar, especialmente o misoprostol. Ambos apresentaram uma efetividade similar, mas os métodos mecânicos estão relacionados a um maior risco de infecção.

Cervical ripening methods have been used for decades, showing different mechanisms, risks and effectiveness. To recognize the existing methods and delineate which have the lower risks, best availability and effectiveness in clinical practice, a critical review was conducted, which sought articles in Medline / Pubmed, Cochrane Library, and LILACS/SciELO regarding mechanical or pharmacological cervical ripening in pregnant women, with terms and keywords related to cervical ripening, misoprostol and induced labor. It was found that the most used methods in practice are synthetic prostaglandin (misoprostol) and the Foley catheter. They seem to be superior to other methods because they are effective, inexpensive and easy to store and use, especially misoprostol. Both showed a similar efficacy, but mechanical methods are related to a higher risk of infection.

In Vitro Effects of Preservative-free and Preserved Prostaglandin Analogs on Primary Cultured Human Conjunctival Fibroblast Cells

PURPOSE: Long-term use of topical medication is needed for glaucoma treatment. One of the most commonly prescribed classes of hypotensive agents are prostaglandin analogs (PGs) used as both first-line monotherapy; as well as in combination therapy with other hypotensive agents. Several side effects of eye drops can be caused by preservatives. The purpose of this study was to evaluate the effects of PGs with varying concentrations of benzalkonium chloride (BAC), alternative preservatives, or no preservatives on human conjunctival fibroblast cells. METHODS: Primary human conjunctival fibroblast cells were used in these experiments. Cells were exposed to the following drugs: BAC at different concentrations, bimatoprost 0.01% (with BAC 0.02%), latanoprost 0.005% (with BAC 0.02%), tafluprost 0.0015% with/without 0.001% BAC and travoprost 0.004% (with 0.001% Polyquad) for 15 and 30 minutes. Cell cytotoxicity was evaluated by phase-contrast microscopy to monitor morphological changes of cells, Counting Kit-8 (CCK-8) assay to cell viability, and fluorescent activated cell sorting (FACS) analysis to measure apoptosis. RESULTS: BAC caused cell shrinkage and detachment from the plate in a dose-dependent manner. Morphological changes were observed in cells treated with bimatoprost 0.01% and latanoprost 0.005%. However, mild cell shrinkage was noted in cells treated with tafluprost 0.0015%, while a non-toxic effect was noted with travoprost 0.004% and preservative-free tafluprost 0.0015%. CCK-8 assay and FACS analysis showed all groups had a significantly decreased cell viability and higher apoptosis rate compared with the control group. However, travoprost 0.004% and preservative-free tafluprost 0.0015% showed lower cytotoxicity and apoptosis rate than other drugs. CONCLUSIONS: This in vitro study revealed that BAC-induced cytotoxicity is dose-dependent, although it is important to emphasize that the clinical significance of toxicity differences observed among the different PGs formulations has not yet been firmly established. Alternatively preserved or preservative-free glaucoma medications seem to be a reasonable and viable alternative to those preserved with BAC.

Conjunctival inflammation in patients under topical glaucoma treatment with indication to surgery / Inflamação conjuntival em pacientes em tratamento tópico para glaucoma com indicação de cirurgia

PURPOSE: To compare the frequency of conjunctival HLA-DR expression (a surrogate marker for inflammation) in eyes treated with topical prostaglandin analogues versus eyes treated with other topical antiglaucomatous drugs. METHODS: Patients diagnosed with primary open-angle glaucoma presenting indication for trabeculectomy were divided in groups according to the use or not of prostaglandin analogues. All subjects were treated with the maximum tolerated dose of antiglaucomatous drugs until the date of the surgery. At the beginning of the surgical procedure, a 5 x 5 mm biopsy of the bulbar conjunctiva was collected, incubated with monoclonal anti-HLA-DR antibody and processed for histological analysis. RESULTS: Of the 31 eyes included (31 patients), 25 were under topical prostaglandin analogues (Group 1) and six under other topical pharmacological agents (Group 2). Fourteen eyes of Group 1 (56%) and three of Group 2 (50 %) were positive for the inflammatory marker HLA-DR (P=1.0). The percentage of stained cells ranged from 15.49 to 48.09% (median: 27.61) in Group 1, and from 18.35 to 28 (median: 20.71) in Group 2, with no differences statistically significant (p=0.33). CONCLUSION: The use of prostaglandin analogues did not increase conjunctival expression of HLA-DR compared to other topical antiglaucomatous agents.

OBJETIVO: Comparar a frequência da expressão conjuntival de HLA-DR (marcador inflamatório) em olhos tratados com análogos de prostaglandinas de uso tópico com a frequência em olhos tratados com outros medicamentos. MÉTODOS: Pacientes com glaucoma primário de ângulo aberto apresentando indicação de trabeculectomia foram agrupados segundo o uso ou não de análogos de prostaglandinas. Todos os participantes foram tratados com medicação máxima tolerada até o momento da cirurgia. Ao início do procedimento cirúrgico, uma biópsia de 5 x 5 mm da conjuntiva bulbar foi coletada, incubada com anticorpo monoclonal anti-HLA-DR e processada para análise histológica RESULTADOS: Dentre os 31 olhos incluídos (31 pacientes), 25 estavam em uso de análogos de prostaglandinas (Grupo 1) e seis em uso de outros agentes antiglaucomatosos (Grupo 2). Quatorze olhos do Grupo 1 (56%) e três do Grupo 2 (50%) apresentaram positividade para o marcador HLA-DR (p=1,0). A porcentagem de células coradas variou de 15,49 a 48,09% (mediana: 27,61%) no Grupo 1 e de 18,35 a 28% (mediana: 20,71%) no Grupo 2, com diferenças não estatisticamente significativas (p=0,33). CONCLUSÃO: O uso de análogos de prostaglandinas não aumenta a expressão conjuntival de HLA-DR comparado com outros medicamentos tópicos para o tratamento de glaucoma.

Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS) / Comparação de custo-efetividade entre a esclerectomia profunda não penetrante e a terapia clínica máxima tolerada para o glaucoma no Sistema Único de Saúde (SUS)

PURPOSE: Non-penetrating deep sclerectomy (NPDS) has emerged as a viable option in the surgical management of open-angle glaucoma. Our aim is to assess the cost-effectiveness of NPDS and to compare it to maximum medical treatment in a 5-year follow-up. METHODS: A decision analysis model was built. Surgical (NPDS) arm of the decision tree was observational (consecutive retrospective case series) and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three-drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]). Cost-effectiveness ratio was defined as direct cost (US dollars) for each percentage of intraocular pressure (IOP) reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS). Incremental cost-effectiveness ratio (ICER) was calculated. RESULTS: Direct cost for each percentage of IOP reduction in 5 years (cost-effectiveness ratio) was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better cost-effectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant. CONCLUSIONS: Despite some limitations, NPDS was both less costly and more effective than maximum medical therapy. From the Brazilian public health perspective, it was the most cost-effective treatment option when compared to maximum medical therapy (FCTD and prostaglandin).

OBJETIVO: A esclerectomia profunda não penetrante (EPNP) é uma opção viável para o tratamento cirúrgico do glaucoma de ângulo aberto. O objetivo deste estudo é avaliar a relação custo-efetividade da EPNP e compará-la com terapia clínica máxima (TCM) em um acompanhamento de 5 anos. MÉTODOS: Um modelo de análise de decisão foi proposto comparando-se o tratamento cirúrgico (EPNP) versus a TCM. A avaliação da EPNP foi observacional retrospectiva de uma série consecutiva de casos e da TCM foi hipotética. A TCM foi considerada como o uso de três drogas (associação de uma combinação fixa de timolol/dorzolamida [CFTD] e um análogo de prostaglandina [bimatoprosta, latanoprosta ou travoprosta]). A relação custo-efetividade foi definida com o custo direto (em dólares) para cada porcentual de redução da pressão intraocular (PIO). A razão de custo-efetividade incremental (ICER) foi calculada. O seguimento foi de 5 anos e a perspectiva dos custos é do Sistema Único de Saúde (SUS). RESULTADOS: O custo direto para cada porcentual de redução da PIO ao final de 5 anos (relação custo-efetividade) foi de US$ 10,19 para a EPNP; US$ 37,45 para a CFTD + bimatoprosta; US$ 39,33 para CFTD + travoprosta; e US$ 41,42 para CFTD + latanoprosta. A EPNP apresentou uma melhor relação custo-efetividade, quando comparada com a TCM. O índice ICER foi negativo, portanto a EPNP foi a opção terapêutica dominante. CONCLUSÃO: A EPNP foi menos custosa e mais efetiva que a TCM. Do ponto de vista do SUS, ela foi a opção mais custo-efetiva, quando comparada com a TCM.

The effects of sevoflurane and propofol anesthesia on cerebral oxygenation in gynecological laparoscopic surgery / 대한마취과학회지

BACKGROUND: Both the Trendelenburg position and pneumoperitoneum with carbon dioxide have been reported to increase intracranial pressure (ICP) and to alter cerebral blood flow or cerebral blood volume. Also anesthetic agents have variable effects on cerebral hemodynamics and ICP. The present study was conducted to determine whether regional cerebral oxygen saturation (rSO2) values differ between propofol and sevoflurane anesthesia during laparoscopic surgery in the Trendelenburg position. METHODS: Thirty-two adult women undergoing gynecological laparoscopic surgery were divided into sevoflurane and propofol groups. rSO2 values were recorded at 10 min after induction in the neutral position (Tpre), 10 min after the pneumoperitoneum in the Trendelenburg position (Tpt) and 10 min after desufflation in the neutral position (Tpost). For analysis of rSO2, we did ANOVA and univariate two-way ANCOVA with covariates being mean arterial pressure and end tidal carbon dioxide tension. RESULTS: Between sevoflurane and propofol groups, the change in rSO2 was significantly different even after ANCOVA. rSO2 at Tpt (76.3 +/- 5.9% in sevoflurane vs 69.4 +/- 5.8% in propofol) and Tpost (69.5 +/- 7.1% in sevoflurane vs 63.8 +/- 6.6% in propofol) were significantly higher in the sevoflurane group compared with the propofol group. In the propofol group, rSO2 at Tpost was significantly lower than at Tpre (71.1 +/- 4.8%) and cerebral oxygen desaturation occurred in two patients (14.3%). CONCLUSIONS: Significantly lower rSO2 values were observed in the propofol group during gynecological laparoscopic surgery. The possibility of cerebral oxygen desaturation should not be overlooked during propofol anesthesia even after desufflation of the abdomen in the neutral position.

Reactivation of Herpetic Keratitis in a Patient after Using Two Different Prostaglandin Analogues

PURPOSE: To report a case of herpetic keratitis after administration of two different prostaglandin analogues. CASE SUMMARY: A 68-year-old female with a history of herpetic keratitis in her right eye after using latanoprost seven years previous presented with redness, mild ocular pain and tearing in the same eye. She had also been prescribed travoprost eye drops for both eyes for uncontrolled glaucoma one month earlier. The cornea in her right eye showed a dendritic epithelial defect with focal epithelial erosions. Travoprost treatment was discontinued, and the herpetic keratitis recovered completely in ten days with acyclovir ointment and oral agent. No further recurrence was observed in the following six months.

Tratamento clínico do glaucoma: pressão-alvo X terapia clínica máxima X terapia clínica mínima / Clinical treatment of glaucoma: target pressure X maximum clinical therapy X minimum clinical therapy / maximum clinical therapy X minimum clinical therapy

Os fundamentos do tratamento clínico do glaucoma, em especial o conceito de pressão-alvo, são apresentados, bem como os principais grupos de drogas atualmente utilizadas e os conceitos de terapia clínica máxima e mínima.

The fundamentals of the clinical treatment of glaucoma, especially the concept of target pressure, are presented, as well as the main groups of drugs currently used and the concepts of minimum and maximum medical therapy.