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ABSTRACT Purpose: Only a few trials have compared the intraocular pressure-lowering effects of prostaglandin analogs to carbonic anhydrase inhibitor plus beta-blocker fixed-dose combination therapy in patients with pseudoexfoliative glaucoma. Furthermore, the influence of the glaucoma stage on the intraocular pressure-lowering effects of these drug types has not been studied. The purpose of this study was to compare the IOP-lowering efficacy of latanoprost, a prostaglandin analog versus dorzolamide/timolol fixed combination, a carbonic anhydrase inhibitor plus beta-blocker fixed-dose combination therapy, in patients with pseudoexfoliative glaucoma based on glaucoma stage. Methods: The data of 32 eyes (32 patients) diagnosed with uniocular pseudoexfoliative glaucoma and treated with topical latanoprost (Group 1) or dorzolamide/timolol fixed combination (Group 2) were retrospectively assessed. The groups were subdivided into early and moderate-advanced stages. Patients' demographics, baseline intraocular pressure, final intraocular pressure, and intraocular pressure difference (the difference between the baseline and final intraocular pressure) were determined from medical records and compared between groups and according to glaucoma stage. Results: The mean drug use duration was 17.7 ± 13.5 months. No significant differences in mean baseline intraocular pressure, mean final intraocular pressure and mean intraocular pressure difference between Groups 1 and 2. In Group 2, the mean intraocular pressure difference was significantly greater in patients with early versus moderate-advanced stage glaucoma (p=0.015). The difference, however, was not detected in Group 1. The mean intraocular pressure difference in early-stage glaucoma was significantly greater in Group 2 versus 1 (p=0.033). Conclusions: Latanoprost and dorzolamide/timolol fixed combination are effective treatments for newly diagnosed pseudoexfoliative glaucoma. In early-stage pseudoexfoliative glaucoma, greater intraocular pressure reduction was noted with dorzolamide/timolol fixed combination than with latanoprost; thus, dorzolamide/timolol fixed combination should be considered when a significant decrease in intraocular pressure is desired in early-stage glaucoma.
RESUMO Objetivo: Estudos limitados examinaram os efeitos de redução de pressão intraocular de análogos de prostaglandina versus inibidor de anidrase carbônica mais terapia de combinação de dose fixa beta-bloqueador em pacientes com glaucoma pseudoesfoliativo. Além disso, a influência do estágio de glaucoma nos efeitos de redução da pressão intraocular desses tipos de drogas não foi avaliada. Este estudo teve como objetivo comparar a eficácia de redução do IOP do latanoprosta, uma combinação fixa análoga de prostaglandina versus dorzolamida/timolol, um inibidor de anidrase carbônica mais terapia de combinação de dose fixa beta-bloqueador, em pacientes com glaucoma pseudoesfoliativo de acordo com o estágio de glaucoma. Métodos: Os dados de 32 olhos (32 pacientes) diagnosticados com glaucoma pseudoesfoliativo monocular e tratados com latanoprosta tópica (Grupo 1) ou combinação fixa de dorzolamida/timolol (Grupo 2) foram avaliados retrospectivamente. Os grupos foram subdivididos em estágios inicial e moderado-avançado. A demografia dos pacientes, a pressão intraocular da linha de base, a pressão intraocular final e a diferença de pressão intraocular (a diferença entre a pressão intraocular da linha de base e a pressão intraocular final) foram determinadas a partir dos prontuários médicos e comparadas entre os dois grupos e de acordo com o estágio de glaucoma. Resultados: A duração média do uso de drogas foi de 17,7 ± 13,5 meses. Nenhuma diferença significativa foi observada entre os grupos 1 e 2 para a média da pressão intraocularda linha de base, média da pressão intraocular final e média da diferença da pressão intraocular. No Grupo 2, a média da diferença da pressão intraocular foi significativamente maior em pacientes com glaucoma de estágio precoce versus moderado-avançado (p=0,015). No entanto, essa diferença não foi observada no Grupo 1. A média da diferença da pressão intraocular em glaucoma de estágio inicial foi significativamente maior no Grupo 2 versus 1 (p=0,033). Conclusões: Terapias com Latanoprosta e dorzolamida/timolol são tratamentos eficazes para glaucoma pseudoesfoliativo recém-diagnosticado. Observou-se em glaucoma pseudoesfoliativo de estágio inicial, uma maior redução da pressão intraocular com combinação fixa de dorzolamida/timolol do que com latanoprosta; assim, a combinação fixa de dorzolamida/timolol deve ser considerada quando uma diminuição significativa da pressão intraocular é almejada em glaucoma de estágio inicial.
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To compare subfoveal choroidal thickness (SFCT) between cases with non-neovascular age-related macular degeneration ( AMD) and neovascular AMD by optical coherence tomography ( OCT ) and to evaluate the contribution of choroidal thickness (CT) measurements to the understanding of pathogenesis of neovascularization in AMD. ●METHODS: Fourty - eigth eyes of 24 patients who had neovascular AMD in one eye and non- neovascular AMD in the other eye were included in this retrospective, cross-sectional study as study group. Forty eyes of healthy,age and axial length matched individuals were selected as the control group. Eyes with drusen and/ or pigmentary changes were included in the non - neovascular AMD subgroup. Eyes with subretinal or intraretinal fluid and/orlipid exudation due to the choroidal neovascularization were included in the neovascular AMD subgroup. OCT measurements were performed with RTVue 100-2 (V 5. 1, Optovue, Fremont, CA, USA) perpendicularly from the outer part of the hyperreflective line ( retinal pigment epithelial layer) to the line corresponding to the choroido-scleral junction. Choroidal thickness was measured at 7 different points, 500μ m intervals up to 1500μ m temporal and nasal to the fovea in the study group and compared statistically between subgroups. ●RESULTS: The mean age of patients was 72. 4±8. 97 (60-82)y. The mean age of healthy individuals was 71. 2±8. 8 (58- 81) y. Mean SFCT of neovascular AMD group were significantly thicker than non- neovascular AMD group (P0. 05). ln neovascular AMD group, there was a statistically significant difference between the mean SFCT and the mean temporal-nasal choroid thickness (P ●CONCLUSlON: Choroidal thickness measurements with OCT device can make a contribution to the understanding the phatophysiology of AMD and large prospective studies should be conducted to understand why SFCT was thicker in neovascular AMD.