Assessment of eye drop instillation technique in glaucoma patients / Técnica de instilação de colírio em pacientes com glaucoma

ABSTRACT Purpose: To study the technique of eye drop instillation in glaucoma patients and identify independent factors that may influence their performance. Methods: In this cross-sectional study, 71 consecutive patients with glaucoma or ocular hypertension, self-administering topical anti-glaucoma medications for ≥6 months were evaluated. All patients instilled a tear substitute into the eye with the worst eyesight using the technique normally used at home. The following parameters were evaluated: age, number of years receiving treatment with ocular hypotensive eye drops, time spent to instill the first drop, number of drops instilled, correct location of the eye drops, contact of the bottle with the eye, closing of the eyelids or occlusion of the tear punctum, and asepsis of the hands. Results: The mean age of the patients was 66 ± 10.8 years, and patients were on ocular hypotensive drugs for 11.3 ± 7.3 (range, 2-35) years. Only 28% of the patients were able to correctly instill the eye drops (squeeze out 1 drop and instill it into the conjunctival sac without bottle tip contact). Touching the tip of the bottle to the globe or periocular tissue occurred in 62% of the patients. In 49% of the patients, the eye drops fell on the eyelids or cheek. Two or more drops were squeezed by 27% of the patients. Conclusions: The majority of glaucoma patients were unable to correctly instill eye drops. Age was an independent factor associated with eye drop instillation performance.

RESUMO Objetivo: Avaliar a técnica de instilação de colírio em portadores de glaucoma e identificar fatores independentes que pode influenciar o desempenho. Métodos: Neste estudo transversal 71 pacientes consecutivos com glaucoma ou hipertensão ocular que auto instilam seus colírios há pelo menos 6 meses, foram avaliados. Todos os pacientes instilaram um colírio lubrificante no olho de pior visão utilizando a mesma técnica de instilação de colírio que utilizam rotineiramente em casa. Foram avaliados parâmetros como: idade, número de anos em tratamento com colírios hipotensores oculares, tempo gasto para instilação da primeira gota, número de gotas instiladas, localização correta do colírio, contato do frasco com o olho, fechamento de pálpebras ou oclusão do ponto lacrimal e assepsia das mãos. Resultados: A idade média dos pacientes foi de 66 ± 10,8 anos. Os pacientes esta vam em tratamento com colírios hipotensores oculares por, em média, 11,3 ± 7,3 anos (variando de 2 a 35 anos). Apenas 28% dos pacientes foram capazes de instilar corretamente o colírio (instilação de 1 gota em saco conjuntival sem contato com a ponta do frasco). Contato da ponta do frasco com o olho ou tecido periocular ocorreu em 62% dos pacientes. Em 49% dos casos, o colírio caiu nas pálpebras ou fora do saco lacrimal na primeira tentativa. Duas ou mais gotas foram instiladas por 27% dos pacientes. Conclusão: A maioria dos pacientes com glaucoma é incapaz de instilar o colírio corretamente. A idade é um fator independente que influencia o desempenho da instilação de colírio.

Lowing-intraocular pressure and improving aqueous humor dynamic effects of qingguangan drug granules in spontaneous glaucoma mice / 中华实验眼科杂志

Background Researches showed that the increase of intraocular pressure (IOP) in glaucomatous eye is associated with the increasing resistance to aqueous humor outflow effects of transforming growth factor-β (TGF-β) and CD44.Qingguangan is a traditional Chinese medicine and used to treat glaucoma.However,its mechanism of lowing-IOP effect is not elucidated.Objective This study was to investigate the lowing-IOP effect and mechanism of qingguangan granule in DBA/2J mouse,a spontaneous glaucoma model mice.Methods Ten 3 month-old female DBA/2J mice with normal IOP were chosen as control group,and 20 spontaneous ocular hypertension mice aged 9 months were randomized into high IOP group and qingguangan-treated group,with 10 mice for each group.The qingguangan (2.5 g/kg) was administered by gavaging twice per day for consecutive 15 days in the qingguangan-treated group,and normal saline solution was used in the same way in the control group and high IOP group.IOP was measured by anterior chamber injection/suction system at a perfusion rate of 2.5 and 5.0 μl/min,respectively,and the coefficient of aqueous outflow facility (C value) and outflow resistance (R value) were calculated.Another 60 3-month-old DBA/2J mice were randomized into blank control group gavaged with normal saline solution and high-,middle-and low-dose qingguangan groups gavaged with 25.00,12.50 and 6.25 g/kg drugs,respectively,and the mouse serum containing drugs was extracted 7 days after treatment.The scleral tissue with trabecular meshwork were obtained for the culture of trabecular meshwork cells and the cells were identified by immunohistochemistry of fibronectin (FN),laminin (LN) and neuronspecific enolase (NSE).TGF-β was added into the medium for 24 hours with the final concentration of 0,5,10,20,50 and 100 ng/ml,and MMT chromatometry was employed to detect the cell vitality.The cells pre-treated with 20 ng/ml TGF-β were treated with different concentration of drug serum for 24,48 and 72 hours,and the level of TGF-β2 receptor in cell supernatant and the expression of CD44 protein in the cells were detected by ELISA and Western blot assay,respectively.Results The IOPs with perfusion both 2.5 μl/min and 5.0μl/min in the qingguangan-treated group and the control group were significantly lower than those in the high IOP group (all at P＜0.01).Compared with the high IOP group,the C value was significantly reduced (2.35±1.34 vs.1.08±0.36) and the R value was evidently elevated (0.64±0.55 vs.1.05± 0.47) in the qingguangan-treated group (all at P＜0.01).Cultured cells were spindle-shaped with the positive response to FN,LN and NSE antibody.The cell vitality was lower in the 5,10 and 20 ng/ml TGF-β group than that in the 0 ng/ml TGF-β group (all at P＜0.05).Compared with the blank control group,the TGF-β2 receptor content in the supernatant and the related expression level of CD44 protein in the cells were elevated in the TGF-β-treated group (all at P＜0.01),and TGF-β2 receptor contents and CD44 expression levels in the TGF-β+high dose drug serum group was significantly lower than those in the TGF-β group and TGF-β +low dose drug serum group 24,48 and 72 hours after culture (all at P＜0.01).Conclusions Qingguangan can lower IOP of spontaneous glaucoma mice by affecting aqueous humor dynamics.Serum containing qingguangan down-regulates the expressions of TGF-β2 receptors and CD44 in trabecular meshwork cells in vitro.

Avaliação da adesão aos colírios em pacientes com glaucoma através da Escala de Morisky de 8 itens: um estudo transversal / Adherence assessment of eye drops in patients with glaucoma using 8 item Morisky Score: a cross sectional study

RESUMO Objetivo: Determinar a adesão aos colírios antiglaucomatosos em pacientes do Projeto Glaucoma (Ministério da Saúde) por meio da escala de Morisky de 8 itens. Métodos: Foi realizado um estudo transversal por meio de questionário aplicado a 237 pacientes diagnosticados com glaucoma inscritos regularmente no Projeto Glaucoma do Instituto de Olhos de Maceió, adaptando a escala de Morisky já validada em português para colírios. As variáveis foram a adesão aos colírios antiglaucomatosos, idade, sexo, raça, tempo de diagnóstico do glaucoma, número de colírios utilizados, doenças sistêmicas, escolaridade, perfil de visão (ruim, razoável ou boa) e os fatores correlacionados com a adesão. A análise estatística entre as variáveis foi realizada com os testes estatísticos do Quiquadrado para as variáveis categóricas e Teste U de Mann-Whitney para as contínuas, considerando um nível de significância de 5%. Resultados: A adesão aos colírios foi de 54%. A idade e o número de colírios (p=0,02 e 0,03 respectivamente) foram estatisticamente relevantes, assim como a qualidade de visão também foi (p<0,001) para o não uso adequado do tratamento. O motivo mais comum tanto no grupo de aderentes como no de não aderentes foi o esquecimento (23% e 76,15% respectivamente). Conclusão: Utilizando a escala de Morisky adaptada para colírios antiglaucomatosos a adesão aos colírios foi de 54% .

ABSTRACT Objective: To determine adherence to glaucoma eye drops in patients from Glaucoma Project (Ministry of Health) by Morisky scale of 8 items. Methods: We conducted a cross-sectional study through a questionnaire applied to 237 patients diagnosed with glaucoma regularly enrolled in the Glaucoma Project at Institutode Olhos de Maceio, adapting the Morisky scale, already validated in Portuguese, for eyedrops. The variables were adherence to antiglaucoma eyedrops, age, sex, race, glaucoma diagnosis time, eyedrops number used, systemic diseases, education, subjective vision (categorized in bad, reasonable or good) and the factors correlated with poor adherence. Statistical analysis between variables was performed with the statistical test Chi-square test for categorical variables and test Mann-Whitney test for continuous outcomes, considering a 5% significance level. Results: The rate of adherence to the glaucoma drops was 54%. The age and number of drops (p = 0.02 and 0,03 respectively), and quality of vision (p<0,001) were statistically significant for the inappropriate use of the therapy and the most common reason both adherent group as the non-adherent was forgetfulness (23% and 76,15% respectively). Conclusion: Using the Morisky scale adapted to antiglaucoma eyedrops the adherence was 54%.

Enoftalmia causada por uso tópico unilateral de Bimatoprost / Unilateral enophthalmos induced by the unilateral use of topical Bimatoprost

RESUMO O autor descreve o caso de uma paciente que apresenta o olho direito com o sulco palpebral profundo e enoftalmia deste lado, tratado durante uma década com Bimatoprost tópica. Concluem que os achados clínicos são provavelmente efeitos colaterais do medicamento.

ABSTRACT The author describes a case report of a patient with unilateral enophthalmia and deep palpebral sulcus probably induced by the topical use of Bimatoprost on the side of the collateral effects described.

Misunderstandings of some problems in glaucoma medications / 眼科

Medication is one of the important methods in treatment of glaucoma, but misunderstandings of some problems during glaucoma medication still exist, such as how to use and evaluate the drugs and when to use the drugs etc. These are reviewed and discussed in this paper.