Preservative-free bimatoprost 0.03% in patients with primary open-angle glaucoma or ocular hypertension in clinical practice.

BACKGROUND: Intraocular pressure (IOP)-lowering medications for primary open-angle glaucoma and ocular hypertension commonly contain preservatives that can cause ocular surface damage in many patients. The purpose of this study was to evaluate the efficacy and tolerability of, and compliance to, preservative-free (PF) bimatoprost 0.03% in patients with primary open-angle glaucoma or ocular hypertension (IOP ≥18 mmHg) in a clinical practice setting. METHODS: This open-label study observed patients who were switched to PF bimatoprost 0.03% for medical reasons. IOP was measured at baseline and ~12 weeks later at the final visit, and the change in IOP was calculated. Tolerability and continuation of therapy were assessed at two follow-up visits. RESULTS: A total of 1,830 patients were included in the study, and complete IOP data were available for 1,543 patients. Mean IOP was reduced by 23% from 21.64 mmHg to 16.59 mmHg (P<0.0001). In subgroup analyses, the mean IOP was significantly reduced compared with baseline, regardless of prior therapy, including those previously treated with PF monotherapy. A total of 85.7% of physicians reported the IOP-lowering efficacy of PF bimatoprost 0.03% to be as expected or better than expected. Adverse events (AEs) were experienced by 5.7% of patients, and there were no serious AEs reported. The most common AEs were eye irritation (1.7%) and hyperemia (1.4%). Physician-reported treatment compliance was reported as better than (48.7%) or equal to (43.6%) prior treatment in most patients. Most patients (82%) were expected to continue PF bimatoprost 0.03% after the end of the study. CONCLUSION: This observational study showed that, in clinical practice, switching to PF bimatoprost 0.03% was associated with a significant IOP reduction from baseline. There was a low AE rate. PF bimatoprost 0.03% may, therefore, be an effective treatment option for patients who are intolerant of preservatives or have an inadequate response to prior IOP-lowering treatments.

Effects of propofol and isoflurane anesthesia on the intraocular pressure and hemodynamics of pigs.

To determine the conditions under which anesthetized pigs can be used in acute noninvasive investigations of ocular hydro- and hemodynamics, the intraocular pressure (IOP) of adult pigs was recorded under the following conditions: (1) after intravenous injection of propofol plus ketamine; (2) during inhalation of isoflurane, and (3) 2 h after topical administration of bimatoprost or (4) timolol. Propofol/ketamine and isoflurane induced significant decreases in the IOP. The pulsation of the ophthalmic artery appeared at a significantly higher IOP in animals anesthetized with isoflurane than in those anesthetized with propofol/ketamine. Bimatoprost and timolol did not significantly decrease the IOP within 2 h after topical administration. It is concluded that different techniques for the acute noninvasive investigation of ocular hydro- and hemodynamics are applicable in anesthetized pigs. To test the effects of antiglaucoma agents, investigation periods longer than 2 h are required. We recommend the use of intravenous propofol/ketamine anesthesia rather than isoflurane anesthesia in future experiments using pigs.

Comparison of data from the rostock cornea module of the heidelberg retina tomograph, the oculus pentacam, and the endothelial cell microscope.

PURPOSE: The aim of this study was to validate data arising from the Rostock Cornea Module (RCM) of the Heidelberg Retina Tomograph. Morphological parameters of the cornea were analyzed according to their dependency on patient's age. METHODS: RCM measurements of 60 healthy eyes within 2 different age groups (group 1 <35 years, group 2 >50 years) were compared with the corneal thickness determined by the Oculus Pentacam and the endothelial cell density measured by the Tomey endothelial microscope, EM-2000. RESULTS: The mean corneal thickness measured with the Heidelberg Retina Tomograph/RCM was 517 +/- 31 microm and 542 +/- 30 microm with the Oculus Pentacam (correlation coefficient, R = 0.78). Group 1 showed a corneal thickness of 509 +/- 24 microm with the RCM and 531 +/- 27 microm with the Pentacam. In group 2, the corneal thickness was 525 +/- 34 microm and 553 +/- 29 microm, respectively. A significant increase in corneal thickness for older patients could be shown. The differences between the methods and the age groups were statistically significant (P < 0.0001). The average endothelial cell density measured with the RCM was 2779 +/- 472 cells per square millimeter. Between the age groups and the methods (RCM and endothelial microscope), no statistically significant differences could be found. Cell densities for the epithelial cell layers and keratocytes showed no significant correlation with age and sex of the patients. CONCLUSIONS: The RCM provides a reliable procedure for the evaluation of all corneal layers including morphological parameters. Endothelial cell densities either determined with the RCM or the EM-2000 are generally comparable to each other and showed no significant differences. It is suggested that lower corneal thickness measurements of the RCM can be caused by pressure during examination. An increased corneal thickness in the older group could be determined with the RCM and the Oculus Pentacam.

Identification of surgeon-individual treatment profiles to support the provision of an optimum treatment service for cataract patients.

One objective of ophthalmological departments is the optimization of patient treatment services. A strategy for optimization is the identification of individual potential for advanced training of surgeons based on their daily working results. The objective of this feasibility study was the presentation and evaluation of a strategy for the computation of surgeon-individual treatment profiles (SiTPs). We observed experienced surgeons during their standard daily performance of cataract procedures in the Ophthalmological Department of the University Medical Center Leipzig, Germany. One hundred five cases of cataract procedures were measured as Surgical Process Models (SPMs) with a detailed-to-the-second resolution. The procedures were performed by three different surgeons during their daily work. Subsequently, SiTPs were computed and analyzed from the SPMs as statistical 'mean' treatment strategies for each of the surgeons. The feasibility study demonstrated that it is possible to identify differences in surgeon-individual treatment profiles beyond the resolution of cut-suture times. Surgeon-individual workflows, activity frequencies and average performance durations of surgical activities during cataract procedures were analyzed. Highly significant (p < 0.001) workflow differences were found between the treatment profiles of the three surgeons. Conclusively, the generation of SiTPs is a convenient strategy to identify surgeon-individual training potentials in cataract surgery. Concrete recommendations for further education can be derived from the profiles.

Early activation of inflammation- and immune response-related genes after experimental detachment of the porcine retina.

PURPOSE: To determine early alterations in retinal gene expression in a porcine model of rhegmatogenous retinal detachment. METHODS: Local detachment was created in eyes of adult pigs by subretinal application of sodium hyaluronate. The gene expression in control tissues and retinas detached for 24 hours was analyzed with a pig genome microarray. Genes with at least three-fold expression changes were detected in the detached retina and in the attached retinal tissue surrounding the local detachment in situ. Structural alterations of the retina were examined by light and electron microscopy. RESULTS: Identified were 85 genes that were upregulated and 7 that were downregulated in the detached retina. Twenty-eight genes were identified as upregulated in the nondetached retina of the surgical eyes. The genes upregulated in detached retinas were related to inflammation and immune responses (n = 52), antioxidants and metal homeostasis (n = 7), intracellular proteolysis (n = 6), and blood coagulation/fibrinolysis (n = 4). The upregulation of at least 15 interferon-stimulated genes indicates elevated interferon levels after detachment. Gene expression of blue-sensitive opsin was not detectable in the detached retinal tissue, suggesting an early reduction in phototransduction, especially in blue cones. Electron microscopy revealed an accumulation of microglial cells in the inner retinal tissue and of polymorphonuclear leukocytes in the vessels of detached and peridetached retinas. CONCLUSIONS: Differentially expressed genes in the retina early after experimental detachment are mainly related to inflammation and immune responses, intracellular proteolysis, and protection against oxidative stress. A local immune and inflammatory response may represent a major causative factor for reactive changes in the retina after detachment. The inflammatory response is not restricted to the detached retina but is also observed in the nondetached retina; this response may underlie functional changes in these regions described in human subjects.

Muller cells are living optical fibers in the vertebrate retina.

Although biological cells are mostly transparent, they are phase objects that differ in shape and refractive index. Any image that is projected through layers of randomly oriented cells will normally be distorted by refraction, reflection, and scattering. Counterintuitively, the retina of the vertebrate eye is inverted with respect to its optical function and light must pass through several tissue layers before reaching the light-detecting photoreceptor cells. Here we report on the specific optical properties of glial cells present in the retina, which might contribute to optimize this apparently unfavorable situation. We investigated intact retinal tissue and individual Müller cells, which are radial glial cells spanning the entire retinal thickness. Müller cells have an extended funnel shape, a higher refractive index than their surrounding tissue, and are oriented along the direction of light propagation. Transmission and reflection confocal microscopy of retinal tissue in vitro and in vivo showed that these cells provide a low-scattering passage for light from the retinal surface to the photoreceptor cells. Using a modified dual-beam laser trap we could also demonstrate that individual Müller cells act as optical fibers. Furthermore, their parallel array in the retina is reminiscent of fiberoptic plates used for low-distortion image transfer. Thus, Müller cells seem to mediate the image transfer through the vertebrate retina with minimal distortion and low loss. This finding elucidates a fundamental feature of the inverted retina as an optical system and ascribes a new function to glial cells.

Ocular complications at the limits of viability.

AIM: To evaluate the incidence of retinopathy of prematurity (ROP) and other ocular morbidities in extremely premature infants. METHODS: A retrospective analysis of the prevalence and nature of ocular abnormalities in a cohort of 22 extremely pre-term infants born <25 + 0 weeks of estimated gestational age (GA) was performed. RESULTS: The children were grouped according to the observed disorder: 13 out of 22 (59%) neonates with mild ophthalmologic findings (ROP < or = stage II) [Group 1], 5 out of 22 (23%) infants with ROP stage III or more (Group 2) and 4 out of 22 (18%) neonates with severe ocular morbidity (congenital cataract, microphthalmia, partial optic nerve atrophy and corneal perforation due to an ulcer with lens protrusion), partly combined with ROP > or = stage III (three of four). One child of 22 (5%) needed laser therapy. Out of 22 admitted infants, 20 (91%) were discharged alive. CONCLUSION: The high rate of ocular morbidity besides ROP in extremely pre-term infants is noteworthy. Mechanisms influencing the postnatal development of the eye, especially their relation to the grade of prematurity and neonatological therapeutical strategies, require further investigations.