Probable ponatinib-induced papilledema in a patient with acute lymphocytic leukemia.

Purpose: Papilledema is a very rare complication of leukemia therapies, and particularly tyrosine kinase inhibitor (TKI) therapy. Targeted oncologic therapies are becoming increasingly popular, so it is increasingly important to report rare adverse effects. We present a case of probable papilledema in the setting of ponatinib therapy for acute lymphoblastic leukemia. Observations: Our patient is a 48-year-old male who was diagnosed with acute lymphocytic leukemia. He underwent stem cell transplantation and shortly after was placed on ponatinib therapy. After initiation of ponatinib, he began to note decreased clarity in the inferonasal visual field of his right eye, corroborated on Humphrey visual field (HVF) testing. Neuroimaging was only notable for a partially empty sella. Lumbar puncture demonstrated opening pressures at the upper limit of normal (23 cm H2O) but with normal cellular constituents and chemistry. Slit lamp exam did not reveal any signs of ocular inflammation. Dilated funduscopic examination (DFE) revealed 360-degree blurring of the right optic disc margin as well as 270-degree blurring of the left optic disc (sparing the temporal border). Optical coherence tomography of the retinal nerve fiber layer (OCT-RNFL) showed increased RNFL thickness of 272 µm in the right eye and 113 µm in the left eye. In the absence of evidence for other possible etiologies of optic disc edema, ponatinib-induced papilledema was suspected. No changes to the ponatinib regimen were made; however, the patient was started on acetazolamide 500 mg twice a day. At three-month follow up, the patient reported resolution of his right eye blurriness and his repeat HVF, OCT-RNFL, and DFE showed resolution of optic disc edema, supporting that his initial bilateral optic disc swelling was likely ponatinib-induced papilledema. Conclusions and importance: This is the first report of probable ponatinib-induced papilledema. This case expands on the literature of TKI induced papilledema and demonstrates successful treatment with an oral acetazolamide regimen.

Omidenepag Isopropyl in Latanoprost Low/Nonresponders With Primary Open Angle Glaucoma or Ocular Hypertension: A Phase 3, Nonrandomized, Two-Phase, Open-Label Study.

PRCIS: This study demonstrates the efficacy and safety of once-daily 0.002% omidenepag isopropyl (OMDI) in patients with primary open angle glaucoma (POAG) or ocular hypertension (OHT) who do not respond or respond poorly to latanoprost. PURPOSE: The purpose of this study was to evaluate the intraocular pressure (IOP)-lowering efficacy and safety of OMDI in latanoprost low/nonresponders with POAG or OHT. MATERIALS AND METHODS: Phase 3, nonrandomized, 2-phase, open-label, multicenter study (NCT03697811) in the United States. Key inclusion criteria included individuals aged 18 years or above, POAG or OHT diagnosis in both eyes, IOP ≥22 mm Hg in ≥1 eye, and ≤34 mm Hg in both eyes at all time points. Overall, 107 patients were enrolled; 104 completed treatment. Included a screening period (≤35-day washout period and 8-week latanoprost run-in period) and a 3-month treatment period comprising one drop of OMDI 0.002% once daily in both eyes. The primary study endpoint was changed from baseline in the mean diurnal (MD) IOP at month 3. Safety endpoints included incidence of adverse events, serious adverse events, and adverse drug reactions. RESULTS: At baseline (visit 4), 75 (70.1%) patients had POAG, 32 (29.9%) had OHT, and 68 (63.6%) had prior use of prostaglandin/prostaglandin analogs (37.4% of whom used latanoprost). The mean (SD) baseline MD IOP was 23.34 mm Hg (2.12). The mean (SD) 3-month (visit 7) MD IOP change from baseline (following latanoprost run-in period and OMDI treatment period) was an additional decrease of 2.96 mm Hg (2.83) ( P <0.0001). No significant safety issues were reported during OMDI treatment. CONCLUSIONS: These data demonstrate OMDI efficacy and safety in latanoprost low/nonresponders with POAG or OHT, suggesting OMDI is a treatment option in the patient population in this study.

Readability and Suitability of Online Patient Education Materials for Glaucoma.

PURPOSE: To assess the quality, content, readability, and accountability of information about glaucoma found online. DESIGN: Cross-sectional study. PARTICIPANTS: Thirteen websites containing patient education materials for glaucoma were analyzed in this study. METHODS: An online Google search was conducted using the keyword "glaucoma." Thirteen medical website results were selected for analysis. Each website was assessed by 3 independent reviewers for suitability, readability, and accountability. The standardized Suitability Assessment of Materials (SAM) tool was used to evaluate the quality and content of information on each website. The Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level (FKGL), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG) index, Automated Readability Index (ARI), and Linsear Write Formula (LWF) score were used to assess the readability of the websites. The Journal of the American Medical Association (JAMA) accountability benchmarks were used to evaluate each website's accountability. MAIN OUTCOME MEASURES: These included SAM, FRE, FKGL, CLI, SMOG index, ARI, and LWF scores as well as JAMA accountability benchmarks. RESULTS: The average SAM score for all the websites included in this study was 18 points out of a possible 34 points. Eyewiki.org was the lowest-scoring website (11.7 ± 0.6 points), whereas aao.org and nei.nih.gov were the highest-scoring websites (26.0 ± 1.0 points and 26.0 ± 2.6 points, respectively). Three content graders in this study were in moderate agreement (kappa statistic = 0.50). The average FRE score among all the websites was 47.0 (95% confidence interval [CI], 39.3-54.7). The average reading grade score among all the websites was 11.2 (95% CI, 10.0-12.4). Two of the 13 websites (15.4%) satisfied all 4 JAMA accountability criteria. CONCLUSIONS: There is significant variation in the content and quality of freely available, online glaucoma education material. The material is generally either not suitable or only adequate for use. Most websites reviewed are written at a reading grade level higher than that recommended for patient education materials.

Risk Factors for Failure of Tube Shunt Surgery: A Pooled Data Analysis.

PURPOSE: To identify the risk factors associated with failure of tube shunt surgery. DESIGN: Pooled analysis of 3 prospective multicenter, randomized clinical trials. METHODS: A total of 621 patients with medically uncontrolled glaucoma were enrolled, including 276 from the Ahmed Baerveldt Comparison Study, 238 from the Ahmed Versus Baerveldt Study, and 107 from the tube group of the Tube Versus Trabeculectomy Study. Patients were randomized to treatment with an Ahmed glaucoma valve (model FP7) or Baerveldt glaucoma implant (model 101-350). The associations between baseline risk factors and tube shunt failure were assessed using a Cox proportional hazards regression model. The primary outcome measure was the rate of surgical failure defined as intraocular pressure (IOP) > 21 mmHg or reduced < 20% from baseline, IOP ≤ 5 mmHg, loss of light perception vision, reoperation for glaucoma, or removal of implant. RESULTS: The cumulative probability of failure after tube shunt surgery was 38.3% after 5 years. In multivariable analyses, baseline factors that predicted tube shunt failure included preoperative IOP (≤ 21 mmHg compared to IOP > 21 and ≤ 25 mmHg; HR, 2.34; 95% CI, 1.52-3.61; P < .001), neovascular glaucoma (HR, 1.79; 95% CI, 1.28-2.52; P = .001), randomized treatment (for Ahmed glaucoma valve; HR, 1.36; 95% CI, 1.04-1.78; P = .025), and age (for 10 year decrease in age; HR, 1.19; 95% CI, 1.09-1.31; P < .001). CONCLUSIONS: Lower preoperative IOP, neovascular glaucoma, Ahmed implantation, and younger age were predictors of tube shunt failure. This Study provides the largest prospectively collected dataset on tube shunt surgery.

Elderly woman with a bleb leak.

PURPOSE: To describe a unique incidence of inadvertent filtering bleb creation after intravitreal injections. OBSERVATIONS: An 84-year-old woman with a history of wet age-related macular degeneration requiring intravitreal injections presented with a Seidel-positive conjunctival cyst. The cyst was in an area where she had received multiple injections and was suspected to be an inadvertent filtering bleb secondary to a full-thickness scleral hole created by these injections. She underwent surgical closure of the fistula and repair of the bleb. CONCLUSIONS AND IMPORTANCE: This case emphasizes the importance of recognizing this potential complication of intraocular injections and outlines steps that should be taken to prevent poor outcomes and vision loss.