Evaluation of anterior chamber angle by van Herick grading and ultrasound biomicroscopy in light and dark conditions for finding appositional angle closure and plateau iris configuration.

PURPOSE: To evaluate association of the van Herick (VH) grades with the ultrasound biomicroscopic (UBM) parameters, appositional irido-trabecular contact (A-ITC) and plateau iris (PI) in a randomly sampled population. METHODS: A 10% random sample of all residents aged 40 or older of the Kumejima study underwent UBM under dark and light conditions in the four quadrants of right eyes. RESULTS: Of 301 right eyes with eligible UBM images, 101 (33.6%) and 200 (66.4%) were classified as VH ≤ 2 and VH ≥ 3, respectively. The UBM parameters on angle width and ciliary body configuration were significantly different between VH ≤ 2 and VH ≥ 3 eyes (p < 0.001). A-ITC was found in at least one quadrant in 54.5% and 75.2% of VH ≤ 2 eyes under light and dark conditions, respectively; and 20.5% and 45.5% of VH ≥ 3 eyes. When 'VH ≤ 2' was used to screen eyes with A-ITC in three or more quadrants, the sensitivity and specificity were 74.1% and 75.3%, respectively. A-ITC was significantly associated with shallower anterior chamber (p = 0.018) and higher intraocular pressure (p = 0.044) in VH ≥ 3 eyes. Plateau iris (PI) was found in 15.8% and 6.0% of VH ≤ 2 and VH ≥ 3 eyes, respectively. Plateau iris (PI) was significantly associated with the UBM parameters on angle width and ciliary body configuration. When 'VH ≤ 2' was used to screen eyes with PI, the sensitivity and specificity were 57.1% and 68.9%, respectively. CONCLUSIONS: The VH grade of ≤2 and ≥3 showed significant association with UBM angle width and ciliary body configuration parameters. The VH ≤ 2 criterion should be useful for screening of A-ITC and PI.

24-hour intraocular pressure in glaucoma patients randomized to receive dorzolamide or brinzolamide in combination with latanoprost.

PURPOSE: To investigate the efficacy of dorzolamide 1% (bid or tid) or brinzolamide 1% bid on 24-hour intraocular pressure (IOP) control as well as patients' preference for either drug when added in combination with latanoprost against glaucoma (IOP, >/=18 mmHg). METHODS: In this randomized crossover study patients were assigned to receive latanoprost plus either dorzolamide or brinzolamide for four weeks. Thereafter, patients underwent 24-hour IOP monitoring while continuing to receive dorzolamide (for two successive days/nights: at first bid then tid) or brinzolamide bid (once overnight). They were then switched over to receive the other test medication for a further four weeks and subsequently reexamined for 24-hour IOP. A questionnaire survey on treatment satisfaction was performed. RESULTS: In 20 patients dorzolamide bid or tid or brinzolamide bid exerted significant (p < 0.001) reductions of IOP from baseline at all time-points over 24 hours; no difference was detected among the treatment regimens. Significantly (p < 0.05) more patients preferred dorzolamide (n = 9) over brinzolamide (n = 2), whereas nine patients gave a neutral answer. CONCLUSION: Dorzolamide bid or tid and brinzolamide bid when combined with latanoprost therapy elicited significant IOP reduction for 24 hours. It is rational to consider patients' preference of therapeutic regimen especially long-term users such as those with glaucoma.

Efficacy and safety of combination therapy with latanoprost after a change in therapeutic regimen from timolol to brinzolamide in Japanese adult patients with primary open-angle glaucoma and ocular hypertension: open, non-randomized 12-week study.

PURPOSE: To compare the efficacy of brinzolamide in Japanese patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH) after a change from timolol in combination therapy with latanoprost. METHODS: A 12-week, prospective, open-label, comparative study was performed in 20 patients [11 males and 9 females, mean age of 64.5 +/- 11.0 (SD)y] with POAG or OH treated with both latanoprost once daily and timolol 0.5% twice daily. During the study brinzolamide was substituted for timolol. Intraocular pressure (IOP) was measured at baseline, 4, 8, and 12 weeks. Blood pressure (BP), pulse rate (PR), and adverse events were also recorded. RESULTS: IOPs at baseline, 4, 8, and 12 weeks were 18.6 +/- 2.1 mmHg, 17.8 +/- 2.6 mmHg, 17.4 +/- 2.5 mmHg, and 17.3 +/- 3.5 mmHg, respectively. IOP reduction at 4 and 8 weeks was statistically significant (p < 0.05). The PR was significantly increased at 12 weeks (p < 0.01), but BP was not significantly affected. Four ocular adverse events were noted, but all were mild and transient. CONCLUSIONS: Substituting brinzolamide 1% for timolol 0.5% in combination therapy with latanoprost 0.005% demonstrated significant IOP reduction with improvement in PR with POAG or OH. Combination therapy using latanoprost and brinzolamide may be recommended for better IOP control with fewer systemic adverse events.

Comparison of latanoprost monotherapy and combined therapy of 0.5% timolol and 1% dorzolamide in chronic primary angle-closure glaucoma (CACG) in Japanese patients.

To compare the efficacy, adverse effects, and patient compliance of latanoprost monotherapy with unfixed combination therapy with 0.5% timolol maleate and 1% dorzolamide in the treatment of chronic primary angle-closure glaucoma (CACG), 36 Japanese patients with CACG following laser iridotomy (LPI) were treated for 12 weeks with instillation of latanoprost alone or with unfixed combination therapy of 0.5% timolol maleate and 1% dorzolamide hydrochloride. After 12 weeks of treatment, latanoprost reduced intraocular pressure (IOP) from 22.2 +/- 2.0 mmHg to 14.8 +/- 1.9 mmHg (33% reduction); timolol maleate and dorzolamide hydrochloride also reduced IOP from 22.5 +/- 2.2 mmHg to 17.1 +/- 2.7 mmHg (24% reduction). Latanoprost monotherapy significantly lowered IOP compared with unfixed combination therapy of 0.5% timolol maleate and 1% dorzolamide hydrochloride. Furthermore, a systemic adverse effect of bradycardia was not observed in the latanoprost monotherapy group. Concerning compliance, no significant difference was observed between the two groups. Thus, latanoprost monotherapy is more effective than unfixed combination therapy with 0.5% timolol maleate and 1% dorzolamide in the treatment of CACG following relief of pupillary block in Japanese patients.