24-hour intraocular pressure and blood pressure levels with latanoprost/timolol fixed combination versus timolol.

PURPOSE: To evaluate 24-hr intraocular pressure (IOP) and blood pressure (BP) with timolol or latanoprost/timolol fixed combination (LTFC). METHODS: Patients with primary open-angle glaucoma or ocular hypertension with normal blood pressure were randomized to LTFC, dosed each evening, or timolol dosed twice daily in a cross-over design for 8 weeks and the opposite medicine for 8 weeks. IOP was measured at 02:00, 06:00, 10:00, 14:00, 18:00 and 22:00 hours in the sitting position with Goldmann applanation tonometry and BP monitoring every 30 min while awake and every hour while asleep at the end of each 8-week treatment period. RESULTS: Twenty-nine patients had a 24-hr baseline IOP of 26.3 +/- 2.5 mmHg, systolic BP (SBP) of 121.4 +/- 12.4 mmHg, diastolic BP (DBP) 72.9 +/- 7.1 mmHg, and ocular perfusion pressure (OPP) of 33.9 +/- 5.7 mmHg. No statistical differences were found between untreated and treated 24-hr SBP, DBP, mean BP (MBP), heart rate, or nocturnal BP dipping status with either medication. LTFC lowered IOP more at each timepoint compared to timolol (difference between treatments 2.7 mmHg, p = 0.0002). CONCLUSIONS: Neither timolol or evening-dosed LTFC reduced SBP, DBP, MBP, OPP, or increased nocturnal dipping. LTFC was more effective than timolol in decreasing IOP.

Evaluation of the acoustic function in pseudoexfoliation syndrome and exfoliation glaucoma: audiometric and tympanometric findings.

PURPOSE: Previous studies have reported increased audiometric thresholds in patients with pseudoexfoliation syndrome (XFS), compared with normative data. This study examines mean audiometric thresholds and tympanometric peak values in patients with XFS and in a control group. METHODS: This is a prospective, nonrandomized control case study. Patients with XFS in one or both eyes constituted the study group (SG). Patients without XFS in either eye constituted the control group (CG). Patients with a history of conditions affecting hearing function were excluded. The SG and the CG included 54 and 48 patients, respectively. Pure tone hearing thresholds levels were measured at 0.25, 1, 2, 3, and 8 kHz. Tympanometric peak values were also recorded. Differences in audiometric mean threshold values and tympanometric peak values between SG and CG, as well as between glaucomatous and nonglaucomatous eyes, were examined. RESULTS: Bone and air audiometric thresholds were significantly increased in SG for 3 kHz and 8 kHz but not for 0.25 kHz, 1 kHz, and 2 kHz. Tympanometric peak values were significantly lower in SG compared with CG. In SG, glaucomatous patients had significantly higher air-conduction thresholds for 3 kHz and 8 kHz. Differences in bone and air audiometric findings as well as tympanometric findings between glaucomatous and nonglaucomatous patients were statistically not significant in CG. CONCLUSIONS: The results agree with previous reports on sensorineural hearing loss in XFS. The reduced tympanometric peak values in SG imply impairment in the elastic properties of the middle ear in XFS. The findings provide additional evidence for the systemic nature of XFS.

Daytime diurnal curve comparison between the fixed combinations of latanoprost 0.005%/timolol maleate 0.5% and dorzolamide 2%/timolol maleate 0.5%.

PURPOSE: The diurnal efficacy and safety of the fixed combinations of latanoprost/timolol given once daily vs dorzolamide/timolol given twice daily in primary open-angle glaucoma or ocular hypertensive patients. DESIGN: A double-masked, two-centre, crossover comparison. RESULTS: In 33 patients, the mean diurnal IOP (0800-2000, measured every 2 h) for latanoprost/timolol fixed combination was 17.3+/-2.2 mmHg and for dorzolamide/timolol, the fixed combination was 17.0+/-2.0 mmHg (P = 0.36). Additionally, there was no statistical difference for individual time points following a Bonferroni correction. A bitter taste was found more frequently with the dorzolamide/timolol fixed combination (n = 6) than the latanoprost/timolol fixed combination (n = 0) (P = 0.040), while the latanoprost/timolol fixed combination demonstrated more conjunctival hyperaemia (n = 9) than the dorzolamide/timolol fixed combination (n = 2) (P = 0.045). One patient was discontinued early from the dorzolamide/timolol fixed combination due to elevated IOP. CONCLUSION: This study suggests that the daytime diurnal IOP is not statistically different between the dorzolamide/timolol fixed combination and latanoprost/timolol fixed combination in primary open-angle glaucoma and ocular hypertensive patients.

Diurnal intraocular pressure reduction with latanoprost 0.005% compared to timolol maleate 0.5% as monotherapy in subjects with exfoliation glaucoma.

AIMS: To compare the diurnal intraocular pressure (IOP) efficacy and safety of timolol vs latanoprost in subjects with exfoliation glaucoma (XFG). METHODS: A 3-month prospective, single-masked, active-controlled, parallel comparison performed in six centres in Greece that randomized subjects in a 1 : 1 ratio to either latanoprost in the evening (2000 hours) and placebo in the morning (0800 hours), or timolol twice daily (0800 and 2000 hours). RESULTS: In all, 103 subjects completed the study. After 3 months of chronic dosing, the latanoprost group exhibited a trend to a greater diurnal IOP reduction from an untreated baseline (24.9+/-3.2-17.4+/-2.9) compared with timolol (24.7+/-2.8-18.3+/-1.9 mmHg) (P=0.07). Latanoprost showed a significantly greater IOP reduction at 0800 hours (-8.5 vs -6.0 mm Hg for timolol, P<0.0001) whereas no difference was observed between the two medications at 1000, 1400, and 2000 hours after a Bonferroni Correction. In addition, latanoprost demonstrated a narrower range of diurnal IOP (2.4) than timolol (3.2 mmHg)(P=0.0017). Safety was similar between groups, except there was more conjunctival hyperaemia with latanoprost (n=8) than timolol (n=1)(P=0.01). CONCLUSIONS: This study suggests that latanoprost provides a statistically lower 08:00-hour IOP and better range of IOP than timolol in the treatment of XFG glaucoma.

The efficacy and safety of the timolol/dorzolamide fixed combination vs latanoprost in exfoliation glaucoma.

PURPOSE: To evaluate the safety and efficacy of the timolol/dorzolamide fixed combination vs latanoprost 0.005% in exfoliation glaucoma patients. METHODS: We randomized in an observer-masked fashion 65 newly diagnosed exfoliation glaucoma patients to either the timolol/dorzolamide twice daily or latanoprost daily treatment for 2 months and then crossed these over to the other treatment. RESULTS: A total of fifty-four patients completed the study. After 2 months of chronic dosing, the morning intraocular pressure (IOP) (10:00) was reduced from a baseline of 31.2+/-6.5 mmHg to 18.1+/-3.0 with the fixed combination and to 18.9+/-4.1 mmHg with latanoprost (P = 0.21). Six patients were discontinued early from both treatment periods owing to inadequate IOP control and two others were discontinued from latanoprost treatment only. The fixed combination showed a significantly greater incidence of taste perversion (P < 0.001) and stinging upon instillation (P = 0.036), while latanoprost showed a trend for increased conjunctival injection (P = 0.056). However, five patients demonstrated either bradycardia or asthmatic symptoms with initiation of the fixed combination therapy. One patient on latanoprost complained of dizziness. Patient preference was generally given to latanoprost (63 vs 20.3%) mainly because of its once daily dosing (P < 0001). CONCLUSIONS: This study suggests that both latanoprost and the timolol/dorzolamide fixed combination are efficacious in the treatment of newly diagnosed exfoliation glaucoma.

Detection of herpes simplex virus in pseudoexfoliation syndrome and exfoliation glaucoma.

PURPOSE: The pathogenesis of pseudoexfoliation syndrome (PEX) remains unknown. An infection, possibly viral, is one of the proposed pathogenetic mechanisms. This study examines the presence of herpes simplex virus (HSV) and varicella-zoster virus (VZV) in iris and anterior capsule specimens of PEX and non-PEX patients. METHODS: Iris and anterior capsule specimens were obtained from 64 patients with PEX (study group, SG) and 61 patients without PEX (control group, CG). The presence of HSV and VZV DNA was evaluated with a polymerase chain reaction (PCR). RESULTS: Herpes simplex virus type I was detected significantly more often in iris specimens from the SG (13.79%), compared to those from the CG (1.75%). Varicella-zoster virus DNA was not detected in any of the examined specimens. CONCLUSION: Results imply a possible relationship between HSV type I and PEX, although no aetiological role of HSV infection in PEX pathogenesis can be established. Results also advocate against any association between VZV and PEX.

Hemorrhagic Descemet's membrane detachment as a complication of deep sclerectomy: a case report.

PURPOSE: To report a case that developed hemorrhagic Descemet's membrane detachment after deep sclerectomy. PATIENT AND METHODS: Case report. A 63-year-old diabetic patient suffering from uncontrolled chronic open-angle glaucoma with full medication, underwent an uneventful deep sclerectomy operation combined with intraoperative Mitomycin-C. RESULTS: On the second postoperative day, a hemorrhagic Descemet's membrane detachment (HDDM) was observed. The hemorrhage showed rapid absorption rate during the first two weeks along with reduction of the HDDM. After this period of time the rate of blood absorption was decreased. The Descemet's membrane reattached completely six months after surgery without any intervention but a paracentral corneal scar was present. The bleb was not functionally impaired during the whole postoperative period, and intraocular pressure remained stable at the level between 12 and 15 mmHg without medication. CONCLUSION: Hemorrhagic Descemet's membrane detachment should be considered as a potential complication of deep sclerectomy.

Crete, Greece glaucoma study.

PURPOSE: To investigate the prevalence of primary open-angle glaucoma (POAG) in a randomized sample of the inhabitants of the island of Crete. PATIENTS AND METHODS: In 18 different villages in all four prefectures of the island of Crete, patients were randomly selected from 1993 through 1998, and an in situ study was accomplished. The sampling fraction (covered by the 1991 census) in each village was approximately 5%. Patients were considered to have POAG when the morphologic aspect of a glaucomatous optic disc was present, and/or a nerve fiber layer defect and a visual field defect was present. The presence of Pseudoexfoliation syndrome (PEX) and pseudoexfoliative glaucoma (PEXG) was also investigated. RESULTS: The prevalence of glaucoma in Crete was 2.80%. Of those diagnosed with POAG, 9.67% had an intraocular pressure (IOP) under 21 mm Hg, and 25.80% had PEX. The prevalence of simple ocular hypertension without glaucoma was found in 6.58% of the patients. The ratio of subjects with hypertensive glaucoma to those with simple ocular hypertension was 1:2.6. CONCLUSION: The prevalence of POAG and exfoliation glaucoma appears to be quite high in Crete. Further research will be needed to set more accurate criteria for earlier diagnosis and to enable more efficient organization of the health care system.

Evaluation of tear secretion and tear film stability in pseudoexfoliation syndrome.

PURPOSE: In pseudoexfoliation syndrome, a material of unknown composition is deposited at the anterior structures of the eye and at periorbital tissues such as the conjunctiva, where goblet cells and accessory lacrimal glands are located. In this study, the possible effect of pseudoexfoliation on tear secretion and tear film stability was investigated. METHODS: Tear film break-up time and Schirmer tests were performed on 108 eyes of 57 patients with pseudoexfoliation and 120 eyes of 60 normal subjects. Results were statistically analyzed. RESULTS: Both Schirmer test and break-up time scores were significantly lower in the pseudoexfoliative patients (average values 10.13 mm and 6.91 sec, respectively) compared to the control group (average values 12.75 mm and 12.75 sec, respectively). The difference was more prominent in males. CONCLUSION: The lower scores in Schirmer and break-up time tests in the pseudoexfoliation group could be attributed to conjunctival involvement. Pseudoexfoliative patients could be more prone to developing xerophthalmia, especially if they are treated with beta blockers.

Loss of heterozygosity in pseudoexfoliation syndrome.

PURPOSE: Pseudoexfoliation (PEX) syndrome is characterized by the accumulation of a material of unknown origin in the anterior structures of the eye. Loss of heterozygosity (LOH) in a genetic locus indicates the presence of a gene located in the same region that could be implicated in the development or the progression of a disease. In this study, the occurrence of LOH in tissues involved in PEX and the possible correlation of LOH incidence with clinical parameters were evaluated. METHODS: Twelve iris specimens, 12 anterior capsule specimens, and respective blood samples were obtained from 17 patients with PEX (13 men), who were undergoing glaucoma and cataract surgery. Sixteen anterior capsule specimens and four iris specimens were obtained from 16 patients without PEX. Polymerase chain reaction was used to amplify 10 highly polymorphic microsatellite markers located on chromosomes 1, 7, 9, and 13. RESULTS: Overall, 83.3% (20/24) of PEX specimens and 94.11% (16/17) of patients with PEX had LOH. The highest incidence of LOH was observed in marker D13S175 (41.6%) followed by D7S478 and D7S479 (37.5%). Only three non-PEX specimens displayed LOH. The number of loci lost was directly related to the altitude of the patients' present residence, but the number lost did not differ significantly between the iris and capsule samples. CONCLUSIONS: The occurrence of LOH in tissues involved in PEX implies a genetic role in PEX pathogenesis at a cellu lar level. The correlation of LOH incidence with the altitude of the patient's residence, could indicate an increased susceptibility to UV radiation of the chromosomal regions examined.

Correlation between age-related macular degeneration and pseudoexfoliation syndrome in the population of Crete (Greece).

OBJECTIVE: To evaluate the epidemiological correlation between age-related macular degeneration and pseudoexfoliation syndrome in the inhabitants of the island of Crete (Greece). SUBJECTS AND METHODS: A total of 777 persons (315 men and 462 women, aged 40-99 years), representing a randomized sample (1.43%) of the Cretan population, underwent slitlamp and fundus examinations according to protocol. The results were statistically analyzed. RESULTS: The prevalence of pseudoexfoliation was 16.1% (21.3% in men and 12.6% in women) and that of maculopathy, 7.9% (11.7% in men and 5.2% in women). The conditions were significantly correlated with each other (P = .002). Also, both displayed a significant direct correlation with age and altitude (for pseudoexfoliation, P<.001 and P = .002 for age and altitude, respectively; for age-related macular degeneration, P<.001 for age and for altitude) and an increase in bilateral incidence with progressing age. CONCLUSIONS: The observed prevalences of pseudoexfoliation and maculopathy were lower than those reported in the mainland of Greece and other Mediterranean regions. The correlation between age-related macular degeneration and pseudoexfoliation syndrome may be explained by the relationship of each disease with age and altitude.

Corneal epithelial wound healing after excimer laser photorefractive and photoastigmatic keratectomy (PRK and PARK).

PURPOSE: This study compared the duration of corneal reepithelialization between photorefractive (PRK) and photoastigmatic (PARK) keratectomy and evaluated the possible correlation of the epithelial healing rate with clinical parameters as well as the refractive outcome. METHODS: The duration until complete reepithelialization was examined in 33 eyes of 33 patients (14 men), not suffering from any known disease, who underwent PRK or PARK surgery. In all cases, a +0.5 diopters (D) therapeutic contact lens (Acuvue Vistakon) was used postoperatively. Clinical parameters such as age, sex, preoperative spherical equivalent, attempted correction, corneal curvature, and surgical plan were recorded in the patient file. All patients received standard medication and were followed up for 12 months postoperatively. Results were statistically analyzed by using the package SPSS 6.0. RESULTS: The duration of reepithelialization was significantly correlated to age and was longer in PARK than in PRK cases and in eyes with an average K reading >43.5D. A shorter reepithelialization period correlated to myopic regression, 1 month postoperatively, but the correlation was annulled thereafter. CONCLUSION: The longer reepithelialization period in older patients and in PARK surgery could be attributed to the age-related decrease in the healing response and to differences in the profile of the ablation area, respectively. Epithelial healing was shorter in eyes with steeper K readings, perhaps because of better contact lens mobility. Understanding the role of factors involved in epithelial healing could allow better postoperative surveillance and treatment.

Microbiological examination of bandage soft contact lenses used in laser refractive surgery.

BACKGROUND: Disposable soft contact lenses are known to be colonized by bacteria and play a key role in bacterial keratitis pathogenesis. Such lenses, commonly used after laser refractive surgery procedures in which postoperative corneal infiltrations are sometimes observed, are potentially a substrate for bacterial inoculation. This study evaluates the extent of such a contamination. METHODS: Sixty disposable lenses collected from 60 eyes of patients who underwent photorefractive keratectomy (PRK), photoastigmatic refractive keratectomy (PARK), or laser in situ keratomileusis (LASIK) for the treatment of myopia or hyperopia were collected under sterile conditions over 4 months and cultured in various media. Results were statistically analyzed and the correlation with clinical and epidemiological data was examined. RESULTS: Eleven (18.3%) of the examined lenses were contaminated with Staphylococcus epidermidis. No other bacteria or fungi were found. Contamination was significantly more common among female patients (P = .036). Correlation with the other clinical or operative parameters examined was statistically insignificant. CONCLUSIONS: Contamination was independent of the surgical procedure and females who were frequent users of eyelid cosmetics displayed higher contamination frequencies, suggesting that bacteria possibly originate from eyelid flora. The isolation of Staphylococcus epidermidis requires close postoperative surveillance, since it is a known cause of keratitis. Prophylactic postoperative treatment with tobramycin, gentamycin, or sulphonamides could be indicated.

Endothelial corneal damage after neodymium:YAG laser treatment: pupillary membranectomies, iridotomies, capsulotomies.

BACKGROUND AND OBJECTIVES: To evaluate the corneal changes after Nd:YAG laser pupillary membranectomies (group A), iridotomies (group B), and capsulotomies (group C) in a follow-up period of 6 months. PATIENTS AND METHODS: The Nd:YAG laser was applied to 3 different groups of patients. Specular microscopy, including the counting of corneal thickness and cell density, the percentage of hexagonal cells, and the cell area, was performed preoperatively and postoperatively. RESULTS: Some dark areas were recorded in the corneal endothelium in groups A and B. A nonstatistically significant decrease of cell density was recorded by the end of the first month. A significant loss of endothelial cells during the sixth month was recorded in groups A and C. CONCLUSION: The appearance of dark areas in the corneal endothelium is mainly related to the total energy delivered. The YAG laser treatments do not provoke an immediate and conspicuous loss of the endothelial cells, but may act as a stimulus for an accelerated loss of endothelial cells.

Needle entrance into the maxillary sinus during retrobulbar anesthesia.

Three patients are presented to whom an accidental needle entrance into the maxillary sinus occurred during retrobulbar anesthesia. In all cases air was aspirated during the aspiration check at the end of needle advancement, and the patients reported a bitter taste after the injection of a small quantity of anesthetic. After withdrawal and careful reinsertion of the needle, maxillary sinus entrance was avoided and a successful retrobulbar block was achieved. Two of the patients had no history of previous facial trauma or surgery, whereas the third had suffered a recent blowout fracture of the orbital floor. The authors suggest that air aspiration or anesthetic passage into the pharynx during retrobulbar anesthesia should raise the suspicion of maxillary sinus entrance, even in patients without any history of facial trauma or surgery. The early recognition of sinus entrance can prevent retrobulbar block failure and reinjection of a second anesthetic dose.

Nd:YAG laser removal of pupillary membranes developed after ECCE with PC-IOL implantation.

PURPOSE: To define the frequency of development of pupillary membranes after ECCE with PC-IOL implantation, and to remove the pupillary membranes using the Nd:YAG laser. METHODS: From 400 patients who had undergone ECCE and were free from local or systemic illness affecting the blood-ocular barrier, 20 eyes developed pupillary membranes Nd:YAG laser was used to remove these pupillary membranes. RESULTS: The frequency of pupillary membranes was found to be 5% (9.8% in pex eyes and 3.3% to the non-pex eyes). Visual acuity improved in 17 eyes by 2 to 5 Snellen lines. No serious complications were observed, endothelium inclusive. CONCLUSION: Pseudoexfoliation might play a significant role in the development of postoperative pupillary membranes which could be successfully treated with the use of Nd:YAG laser. The safety of the procedure has to be evaluated in relation to the corneal endothelium damage in long-term.

Epidemiology of pseudoexfoliation in the island of Crete (Greece).

PURPOSE: To evaluate the pseudoexfoliation (PEX) prevalence in the island of Crete (Greece). METHOD: Organized visits to various villages, to examine a predetermined number of people born and living in these villages, in collaboration with the local birth register offices. RESULTS: PEX prevalence in Crete, in people aged 40 years and more, was found to be 16.1% (men: 21.3%, women: 12.6% - Prefecture of: Heraklion 11.5%, Chania 13.4%, Lasithi 16.9%, Rethymnon 27%). 28.8% of PEX-patients presented IOP > 21 mmHg. In unilateral PEX-patients, mean IOP of PEX-eyes was found to be 17.82 mmHg versus 15.6 mmHg in fellow eyes. CONCLUSION: PEX prevalence was higher in men than in women and increases with age, as does bilaterality. A correlation between increased PEX prevalence and high altitude may exist. PEX is a risk factor for the development of IOP disturbances which seem to appear earlier in women.

Excimer laser phototherapeutic keratectomy for corneal opacities and recurrent erosion.

BACKGROUND: Phototherapeutic keratectomy (PTK) has been used to treat superficial corneal opacities, as well as the recurrent corneal erosion syndrome. METHODS: We performed PTK 6 eyes of 6 patients to treat corneal opacities, and in one eye of another patient to treat recurrent corneal erosion syndrome. Opacities were caused by a healed corneal ulcer, herpetic keratitis, band keratopathy, corneal burn, corneal dystrophy, and an excised pterygium. The follow-up period ranged from 2 to 6 months. RESULTS: Corneal clarity improved to variable degrees in all eyes with corneal opacities. There was no recurrence in the Recurrent Corneal Erosion Syndrome. A hyperopic shift was observed in 2 eyes. CONCLUSIONS: PTK appears to be an effective alternative to penetrating keratoplasty in patients with selected anterior stromal opacities can treat the Recurrent Corneal Erosion Syndrome.