The efficacy of unoprostone isopropyl as an adjunct to topical beta-blocker in patients with open angle glaucoma: a-6-month study.

OBJECTIVES: To assess the efficacy and safety of unoprostone isopropyl as an adjunctive treatment to topical beta-blocker in patients with primary open angle glaucoma (POAG). STUDY DESIGN: This was a prospective, open-label clinical study. MATERIAL AND METHOD: A total of 44 eyes of 22 eligible patients whose intraocular pressure (IOP) was inadequately controlled by topical beta-blocker were enrolled. Inclusion criteria consisted of patients with primary open angle glaucoma who either had IOP measurements > or = 22 mmHg while on topical beta-blocker monotherapy or had IOP measurements > or = 18 mmHg while on dual therapy (topical beta-blocker and a second drug of a different class which was to be discontinued prior to the study to allow washing out of its effects). INTERVENTION: Baseline IOP, pupil size, blood pressure and pulse rate were initially measured; the patients were then examined at 2nd, 4th, 8th, 12th, 18th and 24th weeks of following commencement of topical unoprostone isopropyl therapy (given twice daily). MAIN OUTCOME MEASURES: IOP pupil size, blood pressure and pulse rate were measured and were compared to baseline values. RESULTS: In 44 eyes of 22 eligible patients, unoprostone isopropyl resulted in a statistically significant IOP reduction of 24.6% (p < 0.02). The mean systolic blood pressure decreased from 132.79 +/- 22.11 mmHg (range 100-180 mmHg) at baseline to 125.77 +/- 18.40 mmHg (range 80-160 mmHg) at 24th week after unoprostone isopropyl administration. This reduction was statistically significant (p = 0.002) but was unlikely to have clinical importance. Both mean diastolic blood pressure (p = 0.344), pulse rate (p = 0.306), and pupil diameter (p = 0.107) were not significantly affected. CONCLUSION: Topical unoprostone isopropyl beneficially provides additive IOP lowering effect to topical beta-blocker in patients with primary open angle glaucoma. No serious systemic side effects were found in the present study.

Long-term intraocular pressure change after clear corneal phacoemulsification in Thai glaucoma patients.

OBJECTIVES: To evaluate long-term intraocular pressure (IOP) changes after sutureless clear corneal phacoemulsification in eyes with preoperatively controlled glaucoma. DESIGN: Retrospective study. SETTING: Eye Clinic, Ramathibodi Hospital, Faculty of Medicine, Mahidol University. MATERIAL AND METHOD: The medical records of 218 patients who had uneventful sutureless clear corneal phacoemulsification with acrylic foldable lens (IOL) implantation were retrospectively reviewed. Included were 58 patients with medically controlled open-angle glaucoma and 160 normal controls. Follow-up was 12 to 18 months. Outcome measures were postoperative IOP and number of glaucoma medications. RESULTS: Postoperatively, there was an insignificant decrease in IOP in the glaucoma group; the mean decrease was 1.4 mm Hg +/- 3.8 (SD) at 12 months and 1.6 +/- 4.2 mm Hg at 18 months. The mean number of medications decreased significantly at 12 months (0.51 +/- 0.75) and at 18 months (0.41 +/- 0.83) (P = .04). The control group also had a significant decrease in IOP, with a mean decrease of 0.83 +/- 2.8 mm Hg at 12 months (P = .01) and 1.26 +/- 2.9 mm Hg at 18 months (P < .0001). The decrease in IOP was more pronounced in eyes with a higher preoperative IOP in both the glaucoma and control groups. CONCLUSION: These findings suggest that sutureless clear corneal phacoemulsification with foldable acrylic IOL implantation is a relatively safe and simple surgical option in patients with cataract and well-controlled glaucoma. The approach provided favorable long-term IOP change and led to rapid visual rehabilitation in both the glaucoma and control group.