Effects of Brinzolamide, a Topical Carbonic Anhydrase Inhibitor, on Corneal Endothelial Cells.

INTRODUCTION: This clinical study aimed to investigate the effect of brinzolamide, a topical carbonic anhydrase inhibitor, on corneal endothelial cells (CECs) in patients with glaucoma using a follow-up clinical study design. METHODS: Patients with primary open-angle glaucoma or ocular hypertension were administrated an ophthalmic solution of either latanoprost alone (LT) as a control (n = 18) or latanoprost plus brinzolamide (LT + BR; n = 16). CECs were examined at baseline and at 4, 12, 24, and 48 weeks in 18 and 16 eyes of the LT and LT + BR groups, respectively, using a non-contact specular microscope. CECs were evaluated by parameters, including cell density (CD), coefficient of variation (CV) in cell size, and percentage hexagonality (Hex). RESULTS: Compared with the baseline intraocular pressure (IOP), the mean IOP in the LT group was significantly reduced at 12 and 24 weeks, whereas that in the LT + BR group was significantly reduced at all time points (P < 0.01). The mean CD, CV, and Hex at baseline were not significantly different between the two groups. No significant time-course changes in CD, CV, or Hex were observed in either group. At 48 weeks, there was no significant difference in the mean CD, CV, or Hex between the two groups. CONCLUSION: Patients treated with LT + BR showed significant IOP reduction. However, the use of brinzolamide in addition to latanoprost had no influence on CECs during the one-year follow-up period.

[Dysthyroid optic neuropathy in pregnancy].

BACKGROUND: While development of thyroid eye disease is rarely observed in pregnant women, here we report three cases of pregnant patients with severe dysthyroid optic neuropathy (DON). CASE: Case 1, a 30 year-old woman with thyroid eye disease diagnosed during pregnancy and DON occurring at eight months. Visual acuity was 0.05 in right eye and 0.8 in left. Case 2, a 32 year-old woman with Graves' disease diagnosed during pregnancy and DON occurring at five months. Visual acuity was 0.2 in right eye and 0.09 in left. In cases 1 and 2, since no permission for therapy during pregnancy was obtained from either patient, systemic steroid therapy was performed after delivery. Case 3, a 31 year-old woman with Graves' disease diagnosed during pregnancy. At nine months, DON was diagnosed in both eyes. Visual acuity was 0.07 in right eye and 0.2 in left. An organized systemic steroid therapy following delivery at the end of a normal gestational period was performed. In all three patients, higher levels of thyroid antibodies were observed while thyroid function remained controlled. CONCLUSION: DON developed in pregnant woman with Graves' disease who have higher levels of thyroid antibodies. A close coordination between internists and obstetricians is required for appropriate treatment, including systemic steroid therapy.

A characteristic optic disc appearance associated with myopia in subjects with Graves' ophthalmopathy and in subjects with primary open-angle glaucoma.

PURPOSE: To determine if qualitatively defining the appearance of optic disc change was a valid characteristic of myopia in subjects with Graves' ophthalmopathy (GO) or primary open-angle glaucoma (POAG). METHODS: WE DEFINED TYPICAL TILT APPEARANCE AS THE SIMULTANEOUS PRESENCE OF THE FOLLOWING: an elliptical optic disc, a crescent, unequal sharpness of the cupping margin (horizontally), and nasally displaced vessels in the optic cup. Ninety-two eyes from 92 subjects each with GO or with POAG and no severe complications were included in the study after matching for spherical refractive errors. Using our definition of tilt appearance, two independent observers subjectively judged optic disc photographs. One observer repeated judgments in 70 randomly selected eyes and judgment reproducibility was assessed using kappa statistics. Tilt ratio was used as a quantitative parameter. RESULTS: The numbers of eyes judged as having a typical tilt appearance in the GO group and in the POAG group were 25 (27.2%) and 39 (42.4%), respectively, by one observer (P = 0.0297), and 12 (13%) and 44 (47.8%), respectively, by another observer (P < 0.0001). Intra- and interobserver reproducibility of tilt judgment were very good (kappa = 0.93) and good (kappa = 0.65), respectively. Tilt ratio did not significantly differ between the two groups. Analytical results including background factors were essentially the same for the two observers: multivariate logistic regression for one observer's judgment showed that the presence of the typical tilt appearance was associated with belonging to the glaucoma group (odds ratio [OR], 6.25; P = 0.0054), tilt ratio (OR per 0.01, 0.77; P < 0.0001), and spherical refractive error (OR per diopter, 0.80; P < 0.003). CONCLUSION: The optic disc feature we designated as typical tilt was associated with myopia, and its frequency was higher in subjects with POAG compared to those with GO.

Proptosis in dysthyroid ophthalmopathy: a case series of 10,931 Japanese cases.

PURPOSE: This observational case series investigated the occurrence and distribution of proptosis in Japanese patients with dysthyroid ophthalmopathy (DO). The relationship among lid retraction, lid swelling, and enlargement of extraocular muscles was also analyzed. METHODS: From 1993 to 2002, 10 931 patients (2240 men and 8691 women, average age; 39.9 ± 14.0 years) with abnormal thyroid function were examined for proptosis. Proptosis was measured using a Hertel exophthalmometer, and lid swelling and retraction were classified. Orbital magnetic resonance imaging or computed tomography was used to quantify enlargement of the extraocular muscles. RESULTS: Clinically significant proptosis (≥15 mm) was present in 74.2% patients and was classified as mild (15-17 mm, 39.1%), moderate (18-20 mm, 25.9%), or severe (>20 mm, 9.2%). The average exophthalmometer reading was 17.2 ± 3.2 mm, with proptosis less pronounced with age (p < 0.001) and more pronounced in men than women (18.2 ± 3.4 mm vs. 17.0 ± 3.1 mm; p < 0.001). Lid retraction was present in 57.7% of patients, lid swelling in 46.9%, and muscle enlargement in 40.8% of patients. Multiple regression analysis revealed proptosis was strongly correlated with a young age and the male gender, followed by extraocular muscle enlargement and lid retraction and swelling (p < 0.001). CONCLUSIONS: This study assessed the measurable features of proptosis in Japanese patients with DO and contributes to the understanding by correlating symptoms and signs of DO.

[Ophthalmic surgery on Graves' ophthalmopathy].

We evaluated various ophthalmic surgeries for patients with Graves' ophthalmopathy. In 2005, surgical procedures were employed on 178 patients with Graves' ophthalmopathy (male 69, female 109). Eyelid surgery was indicated for treatment of various anterior eye changes. Eyelid surgery was employed on 121 eyes of 84 cases. Extraocular muscle surgery was performed on 138 eyes of 105 cases, simple type 86 cases and complex type 19 cases. The cicatrical adhesion to the surface of the affected muscle was always observed. Orbital decompression was performed on 57 eyes of 33 cases. Better results and few complications were considered attributable to the stabilization of orbitopathy before surgery.