Hemorrhagic choroidal detachment after use of anti-glaucomatous eye drops: case report / Descolamento hemorrágico de coroide após o uso de colírios antiglaucomatosos: relato de caso

Eighty-two-year-old patient with a pacemaker using warfarin due to arrhythmia and having an intraocular lens in the right eye, developed spontaneous hemorrhagic choroidal detachment one day after the use of combined preparation of 0.5% timolol maleate and 0.004% travoprost, due to primary open-angle glaucoma. Hemorrhagic detachment was detected by anterior and posterior segment examination, as well as B-scan ultrasonography. After the detachment, excessive increased intraocular pressure was controlled with oral carbonic anhydrase inhibitor, cycloplegic and steroid therapy. After four months, visual acuity was 20/20 and the intraocular pressure was under control with 0.5% timolol maleate and 1% brinzolamide. Controlled reduction of the intraocular pressure should be considered, particularly in older patients under anticoagulant therapy and that had undergone prior ocular surgery.

Paciente de oitenta e dois anos de idade com marca-passo e utilizando varfarina devido à arritmia cardíaca e com uma lente intraocular no olho direito, desenvolveu descolamento de hemorrágico espontâneo de coroide um dia após o uso de colírio combinado de maleato de timolol a 0,5% e travoprosta a 0,004%, devido ao glaucoma de ângulo aberto primário. O descolamento hemorrágico foi detectado por análise do segmento anterior e posterior, bem como ultrassonografia modo B. Após o descolamento, o aumento excessivo da pressão intraocular foi controlado por inibidor da anidrase carbônica via oral, terapia cicloplégica e esteroides. Após quatro meses, a acuidade visual era 20/20 e a pressão intraocular estava sob controle com o maleato de timolol a 0,5% e brinzolamida a 1%. A redução controlada da pressão intraocular deve ser considerada, especialmente em pacientes idosos sob terapia anticoagulante e que tinham sido submetidos à cirurgia ocular prévia.

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 ...

Efficacy of bimatoprost 0.03% in reducing intraocular pressure in patients with 360° synechial angle-closure glaucoma: A preliminary study.

Context: Peripheral anterior synechiae (PAS; synechiae anterior to functional trabecular meshwork) formation in primary angle-closure glaucoma (PACG) hampers access to uveoscleral outflow. Thus, the role of bimatoprost in such patients with 360° synechiae was evaluated. Aims: To assess efficacy and safety profile of bimatoprost 0.03% in lowering intraocular pressure (IOP) in 360° synechial angle-closure glaucoma patients. Settings and Design: This was a prospective, non-randomized, non-comparative, selective analysis, single-center pilot study. Materials and Methods: A total of 23 eyes of 20 Indian chronic angle-closure glaucoma (CACG) patients with IOP greater than 21 mmHg, 360° PAS and no visual potential in the study eye underwent detailed eye examination. Baseline IOP was measured and YAG peripheral iridotomy was performed for complete angle-closure reconfirmation. Bimatoprost 0.03% was administered for 8 weeks as once-daily evening dose. IOP reduction within treatment group was determined with “paired t-test”. Results: The mean reduction in IOP from baseline to 8 weeks of bimatoprost therapy was 15.3 ± 9.5 mmHg (P < 0.001). The most commonly observed adverse event was conjunctival hyperemia (35%). Bimatoprost was well tolerated in the study. Conclusions: In this study, exclusively involving patients with 360° synechial angle-closure glaucoma and no visual potential, bimatoprost 0.03% treatment demonstrated a statistically significant IOP reduction. Hence, it can be inferred that bimatoprost 0.03% is an efficacious treatment modality in this subgroup of patients for reducing IOP.

Eficácia do latanoprosta x travoprosta avaliada pela curva diária de pressão intraocular / Efficacy of latanoprost versus travoprost assessed by daily intraocular pressure curve

OBJETIVO: Avaliar, através da curva diária de pressão intraocular (CDPo), a eficácia do latanoprosta (L) e do travoprosta (T) como monoterapia e do L e T associados ao maleato de timolol 0,5 por cento (LTim 0,5 por cento e TTim 0,5 por cento) em pacientes glaucomatosos. MÉTODOS: Análise retrospectiva da curva diária de pressão intraocular de pacientes glaucomatosos em uso de L ou T ou das associações LTim 0,5 por cento e TTim 0,5 por cento. Foram excluídos os pacientes que não usaram a(s) medicação(ões) de maneira correta na curva diária de pressão intraocular e aqueles que estavam em uso de L ou T associado a outro hipotensor qão o timolol 0,5 por cento ou em uso de mais de dois colírios antiglaucomatosos. Foram analisados, em cada grupo, a pressão média (Pm) e a variabilidade (V) e seus respectivos desvios padrões. Utilizou-se o programa SPSS 11.0 na análise estatística. Raça, idade, sexo e tipo de glaucoma não foram critérios para a inclusão ou a exão dos pacientes. RESULTADOS: Foram incluídos 75 pacientes (142 olhos) com idade média de 61,7 anos, sendo 33 (44,0 por cento) do sexo masculino e 42 (56,0 por cento) do feminino. Treze pacientes (26 olhos - 18,3 por cento) usavam L; 18 pacientes (33 olhos - 23,2 por cento) usavam T; 18 pacientes (32 olhos - 22,5 por cento) estavam em tratamento com LTim 0,5 por cento e 26 pacientes (51 olhos - 35,9 por cento) usavam a associação TTim 0,5 por cento. Sessenta e nove pacientes (92,0 por cento) eram portadores de glaucoma crônico simples; 5 (6,7 por cento) de glaucoma congênito e 1 (1,3 por cento) de glaucoma pós-pseudofacia. Nos grupos L e T, os valores da Pm foram 15,2 (± 4,2) mmHg e 14,8 (±3,2) mmHg e os da V foram 2,0 (± 1,2) e 3,2 (± 1,9), respectivamente. Nos grupos LTim 0,5 por cento e TTim 0,5 por cento, os valores da Pm foram 14,9 (± 2,2) mmHg e 15,0 (±3,2) mmHg e os da V foram 2,4 (± 1,2) e 2,8 (± 1,6), respectivamente. Não houve diferença estatisticamente significativa na Pm entre ...

PURPOSE: To assess the efficacy of latanoprost (L) and travoprost (T) as monotherapy as well as both drugs associated with 0.5 percent timolol maleate twice a day regarding the daily curve of intraocular pressure (DCPo) with the measurement of intraocular pressure (IOP) at 6 am in bed. METHODS: Retrospective study analyzing the daily curve of intraocular pressure of patients treated with L or T with or without 0.5 percent Tim. Patients who did not correctly follow the treatment were excluded. We also excluded the patients who used the prostaglandin analog associated with any other antiglaucomatous drug different from 0.5 percent Tim and those who were treated with more than two antiglaucomatous drugs. Statistical analysis was made through the SPSS 11.0 program calculating mean intraocular pressure (Pm), variability (V), p value and standard deviation. Ethnic aspects or type of glaucoma were no criteria of inclusion or exclusion in this study. RESULTS: Seventy-five patients (142 eyes) were included. The average age was 61.7 years. Thirty-three (44.0 percent) patients were male and 42 (56.0 percent) were female. Thirteen patients (26 eyes 18.3 percent) used L, 18 patients (33 eyes - 23.2 percent) were treated with T, 18 patients (32 eyes - 22.5 percent) used latanoprost and 0.5 percent timolol (L 0.5 percentTim) and 26 patients (51 eyes - 35.9 percent) used travoprost and 0.5 percent timolol (T 0.5 percentTim). Chronic simple glaucoma was the most common type (92.0 percent), followed by congenital glaucoma (6.7 percent) and glaucoma secondary to cataract surgery (1.3 percent). Pm was 15.2 (± 4.2) mmHg among those treated with L and 14.8 (± 3.2) mmHg among the T users. Those patients showed a V of 2.0 (± 1.2) and 3.2 (± 1.9). In the group of L 0.5 percentTim and T 0.5 percentTim the Pm and V were 14.9 (± 2.2) mmHg, 15.0 (± 3.2) mmHg, 2.4 (± 1.2) and 2.8 (± 1.6) respectively. No statistical significant difference was found in the Pm neither ...

Considerações sobre o ângulo de administração de colírios antiglaucomatosos análogos das prostaglandinas / Considerations about administration angle of prostaglandin analogs

OBJETIVO: Investigar se há diferença no peso e volume das gotas de colírios análogos das prostaglandinas em ângulos de gotejamento de 45º e 90º com relação ao plano horizontal. MÉTODOS: Foi realizado estudo experimental utilizando os colírios latanoprosta, travoprosta e bimatoprosta, pelo qual se gotejava as soluções com angulação de 45º e 90º. Estes colírios foram escolhidos em virtude do seu uso rotineiro em oftalmologia e do seu custo. A primeira gota e dez gotas seguintes foram pesadas em ângulo de 45º e 90º. A análise estatística foi realizada por meio do programa SPSS® 12.0 (Microsoft), utilizando o teste de variância ANOVA, sendo considerada diferença estatisticamente significante um valor P<0,001. RESULTADOS: Verificou-se que há diferença no peso, e conseqüentemente no volume, das gotas instiladas a 45º e a 90º dos colírios de travoprosta e bimatoprosta. Para o colírio travoprosta o gotejo a 45º produz uma gota menor que em 90º. O inverso ocorre para o colírio de bimatoprosta. Já para o colírio de latanoprosta, não houve diferença estatisticamente significante. CONCLUSÕES: Como houve diferença estatística no peso das gotas de dois colírios análogos das prostaglandinas e em outro não se verificou esta variação, - e como este possui relação direta com o volume - infere-se que devemos ser críticos diante de estimativas de custo ou duração da terapia com base no gotejamento dos colírios considerando número de gotas por frasco e volume.

PURPOSE: To investigate if there is any difference in volume and drop weight of prostaglandin analogs when adopting drip angles of 45º and 90º, regarding a horizontal line. METHODS: An experimental study was conducted using the follow ophthalmic solutions: latanoprost, travoprost and bimatoprost. In this study the ophthalmic solutions were dripped according to an angle of 45º or 90º. Prostaglandin analogs were chosen due to their common use in ophthalmology and their cost. The first drop and other ten drops were weighed, alternating the drip angle (45º or 90º). Statistical analysis was done with SPSS® 12.0 (Microsoft), using quantitative comparisons with the ANOVA test. An odds value (P) below 0.001 was considered a statistical significant difference. RESULTS: We verified differences in weight and size of the travoprost and bimatoprost drops instilled at 45º and 90º. The drip at 45º produces a smaller drop of travoprost (P<0.001), and the inverse occurs for bimatoprost. There were no statistical significant differences in weight of latanoprost drops according to the instillation angle. CONCLUSIONS: Once there was statistical difference in weight - which has direct relationship with size - of the drops of two kinds of prostaglandin analogs and in another one we did not observe this variation, we infer that cost and therapy duration estimates should be analyzed carefully, especially if this kind of drip measure is used.

Carotid cavernous sinus fistula presenting with pulsating exophthalmos and secondary glaucoma.

Carotid cavernous sinus fistula is abnormal communications between the carotid arterial system and the venous cavernous sinus. Carotid cavernous sinus fistula can develop either because of trauma or spontaneous causes. Spontaneous carotid cavernous sinus fistula is often associated with a pre-existing aneurysm in the intracavernous portion of internal carotid artery. However, these fistulas may be congenital arteriovenous connections that open spontaneously in the settings of collagen vascular disease, atherosclerosis, hypertension, or may develop in females during peripartum period. A case of spontaneous carotid cavernous sinus fistula in a young adult male who presented with pulsating exophthalmos and secondary glaucoma is presented. Characteristic features of arteriovenous fistula--bruit, thrill, corkscrew episcleral vessels were present. Radiological investigations were done to confirm the diagnosis. Transvenous embolisation was done to close the fistula.

Conjunctival changes induced by prostaglandin analogues and timolol maleate: a histomorphometric study

PURPOSE: To compare histological changes induced by antiglaucoma medications in the rabbit conjunctiva. METHODS: Fifty New Zealand rabbits were divided in 5 groups of 10 animals. The left eyes were treated daily with one drop of bimatoprost 0.03 percent, travoprost 0.004 percent, latanoprost 0.005 percent, timolol maleate 0.5 percent or artificial tears containing benzalkonium chloride (BAK) for 30 days. The right eyes served as controls. Superior limbic conjunctival biopsies were performed at the 8th and 30th day in 5 rabbits of each group. The conjunctiva was fixed with 10 percent formaldehyde, followed by HE and PAS staining. Morphohistometric quantitative analyses were performed to evaluate the following parameters: inflammatory infiltrate, epithelial thickness, number of goblet cells, diameter and number of blood vessels. RESULTS: At the 8th and 30th posttreatment days, all groups, except one that received artificial tears, exhibited a diffuse inflammatory infiltrate, composed by lymphocytes and neutrophils, which was denser in the timolol group than in the prostaglandin (PG) analogues groups. At the 30th day, the timolol group also showed an increased subepithelial collagen density and a significant increase in epithelial thickness (p=0.0035). The goblet cell density was significantly increased at the 8th day in the group treated with travoprost (p=0.0006), and at the 30th day in those treated with bimatoprost (p=0.0021) and latanoprost (p=0.009). CONCLUSIONS: Although a moderate, diffuse inflammatory infiltrate was observed in PG-treated eyes, no changes in conjunctival epithelial thickness or subconjunctival collagen density were observed with these medications, suggesting that these drugs induce fewer changes than timolol maleate in the rabbit conjunctiva.

OBJETIVOS: Comparar alterações histológicas induzidas por medicação anti-glaucomatosa na conjuntiva de coelhos. MÉTODOS: Cinqüenta coelhos da raça Nova Zelândia foram divididos em 5 grupos de 10 animais. Os olhos esquerdos foram tratados com uma gota diária de bimatoprosta 0,03 por cento, travoprosta 0,004 por cento, latanoprosta 0,005 por cento, maleato de timolol 0,5 por cento ou lágrimas artificiais contendo cloreto de benzalcônio (BAK) por 30 dias. Os olhos direitos serviram como controles. Foram realizadas biópsias conjuntivais límbicas superiores no 8º e 30º dias em 5 coelhos de cada grupo. A conjuntiva foi fixada com formaldeído 10 por cento, seguido por coloração de HE e PAS. Foi realizada análise quantitativa morfohistométrica para avaliar os seguintes parâmetros: infiltrado inflamatório, espessura epitelial, número de células caliciformes, diâmetro e número de vasos sanguíneos. RESULTADOS: No 8º e 30º dias de tratamento, todos os grupos, exceto aquele que recebeu lágrimas artificiais, exibiram infiltrado inflamatório difuso, composto por linfócitos e neutrófilos, sendo mais denso no grupo timolol do que nos grupos dos análogos de prostaglandinas. No 30º dia, o grupo timolol apresentou um aumento na densidade de colágeno subepitelial e um aumento significativo da espessura epitelial (p=0,0035). A densidade de células caliciformes aumentou significativamente no 8º dia no grupo tratado com travoprosta (p=0,0006), e no 30º dia nos grupos tratados com bimatoprosta (p=0,0021) e latanoprosta (p=0,009). CONCLUSÕES: Embora tenha sido observado um infiltrado inflamatório difuso e moderado nos olhos tratados com análogos de prostaglandinas, não houve alterações na espessura epitelial conjuntival ou densidade colágena subepitelial com essas medicações, sugerindo que essas drogas induzem menores alterações que o maleato de timolol na conjuntiva de coelhos.

Recurrence of bilateral herpes simplex virus keratitis following bimatoprost use.

A 76-year-old man presented with features of bilateral herpes simplex virus (HSV) keratitis. It was found to be recurrence of bilateral HSV keratitis following the use of Bimatoprost eye drops for uncontrolled intraocular pressure in a case of bilateral primary open-angle glaucoma.

Efficacy and safety of bimatoprost for the treatment of open-angle glaucoma and ocular hypertension: a three-month, open-label study in community-based practices in Thailand.

The authors evaluated the effectiveness and safety of bimatoprost using an open-label, non-comparative, three-month, community-based surveillance study. Patients (n = 458) with open-angle glaucoma or ocular hypertension received bimatoprost 0.03% ophthalmic solution as monotherapy, replacement therapy or adjunctive therapy. Bimatoprost produced a rapid, significant (p < 0.0001) reduction in intraocular pressure: monotherapy (34.6% reduction), replacement therapy (16.4% reduction); adjunctive therapy (24.1% reduction). Bimatoprost enabled more patients to achieve their pre-defined target intraocular pressure (p < 0.0001), compared to previous treatments, and significantly lowered intraocular pressure, regardless of the patients' baseline pressure level or history of pressure control. Bimatoprost was well-tolerated; the most commonly reported adverse event was conjunctival hyperaemia (19.9%). Most patients and ophthalmologists rated bimatoprost highly, compared to previously used treatments. The authors concluded that bimatoprost is an effective, well-tolerated treatment for lowering intraocular pressure in Thai patients with open-angle glaucoma or ocular hypertension.