Netarsudil as a Predictor of Response for MicroPulse Transscleral Laser Therapy: A Pilot Study.

PURPOSE: To investigate the role of netarsudil as an outcome predictor of MicroPulse transscleral laser therapy (MPTLT). DESIGN: Retrospective comparative study. SUBJECTS: Forty-seven eyes in 33 adult patients with glaucoma with a minimum of 1 month of follow-up after netarsudil treatment and 3 months of follow-up after MPTLT were included. Eyes receiving intraocular pressure (IOP)-lowering procedures in the interim were excluded. INTERVENTION: Ophthalmic eyedrops of netarsudil at 0.02%, followed by MPTLT treatment. MAIN OUTCOME MEASURES: Correlation of success between netarsudil and MPTLT. Netarsudil success was defined as an IOP reduction ≥ 20% from baseline, whereas MPTLT success was defined as an IOP reduction ≥ 20% without additional IOP-lowering medications. Secondary outcomes included success rates, mean IOP reduction, adverse effects after each treatment, and netarsudil discontinuation rate. RESULTS: We found a positive correlation between the netarsudil response and the subsequent MPTLT response (odds ratio, 3.73; 95% confidence interval, 1.05-13.24; P = 0.041). Among netarsudil responders, 73.7% (14/19) of eyes subsequently responded to MPTLT, whereas among netarsudil nonresponders, 42.8% (12/28) of eyes subsequently responded to MPTLT (P = 0.037). From netarsudil, 44.4% of eyes were successful; from MPTLT, 55.3% of eyes were successful. The mean IOP reductions were 2.83 ± 5.74 mmHg from netarsudil and 3.15 ± 6.43 mmHg from MPTLT. Overall, the rate of netarsudil discontinuation was 55.3%. The most common reasons for netarsudil discontinuation were adverse effects (48.9%), followed by high cost (19.1%). The most common adverse effects to netarsudil were conjunctival hyperemia (48.9%) and blurred vision (8.5%). There were no adverse events reported after MPTLT. After MPTLT, 29.8% of eyes required additional IOP-lowering procedures. CONCLUSIONS: The netarsudil response may serve as a predictive marker of the MPTLT response, with over 70% of netarsudil responders subsequently responding favorably to MPTLT in this study.

Evaluation of eyedrop administration by inexperienced patients after cataract surgery.

PURPOSE: To evaluate efficacy and safety of eyedrop administration after cataract surgery and to identify predictors of better technique in patients without previous eyedrop experience. SETTING: Department of Ophthalmology, McGill University, Jewish General Hospital, Montreal, Quebec, Canada. DESIGN: Prospective cross-sectional study. METHODS: Eyedrop-naïve postoperative cataract patients were consecutively recruited the day after cataract surgery. Data were collected using a standardized self-reporting questionnaire and a chart review and by videotaping patients administering the drops in the operated eye. Two independent observers objectively evaluated the instillation technique. Predictors were assessed using odds ratios (ORs) from a logistic regression model. RESULTS: The study enrolled 54 patients. Subjectively, 17 patients (31%) reported difficulty instilling the eyedrops. Sixty-nine percent reported always washing their hands before using the drops, 42% believed that they never missed their eye when instilling drops, and 58.3% believed they never touched their eye with the bottle tip. Objectively, 50 patients (92.6%) showed an improper administration technique, including missing the eye (31.5%), instilling an incorrect amount of drops (64.0%), contaminating the bottle tip (57.4%), or failing to wash hands before drop instillation (78.0%). A better performance score was significantly associated with having received instructions on how to use drops (OR, 11.99; P=.011). CONCLUSIONS: Postoperative cataract patients inexperienced with eyedrop use showed a poor instillation technique by failing to wash hands, contaminating bottle tips, missing the eye, and using an incorrect amount of drops. There was a large discrepancy between the patients' perceptions and the observed technique of drop administration. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Traumatic disruption of the optic chiasm.

A 27-year-old man developed a persistent bitemporal hemianopia after severe head trauma sustained in a high-speed motor vehicle accident. The initial brain MRI revealed hemorrhagic contusion of the optic chiasm. A brain MRI performed 4 weeks later demonstrated complete chiasmal transection, a phenomenon rarely documented with imaging.