Ganglion cell complex thickness in nonexudative age-related macular degeneration.

PURPOSE: TO evaluate ganglion cell complex (GCC) thickness with spectral domain optical coherence tomography (SD-OCT) in eyes with nonexudative age-related macular degeneration (NEAMD). METHODS: Forty-seven eyes of 28 patients with nonexudative age-related macular degeneration (NEAMD) and 54 eyes of 28 age-matched healthy subjects were enrolled. Each subject underwent a complete ophthalmic examination before SD-OCT were obtained. Macular scans were taken with software version 6.0 of the ganglion cell analysis (GCA) algorithm. GCC thickness was evaluated automatically as the average, minimum, temporal superior, superior, nasal superior, nasal inferior, inferior, and temporal-inferior segments by SD-OCT and parameters were compared between groups. RESULTS: The mean age was 68.7±8.73 years in patient group, and 61.51±5.66 years in control group. There were no significant differences in mean age, gender distribution, intraocular pressure, and sferic equivalent at imaging between the groups (P>0.05). The mean (±SD) GCC thicknesses were as follows; average 71.53±16.53 µm, minumum 62.36±21.51 µm, temporal superior 72.23±14.60 µm, superior 72.76±20.40 µm, nasal superior 72.31±20.13 µm, nasal inferior 69.74±20.51 µm, inferior 69.38±19.03 µm, and temporal-inferior 73.12±15.44 µm in patient group. Corresponding values in control group were 81.46±4.90 µm, 78.66±6.00 µm, 81.51±4.66 µm, 82.94±5.14 µm, 81.79±5.86 µm, 80.94±6.18 µm, 80.14±6.30 µm, and 81.75±5.26 µm, respectively. There were significant differences between two groups in each segments (Mann-Whitney U-test, P<0.05). CONCLUSION: The average GCC thickness values (in all segments) of NEAMD patients were lower than control group. NEAMD, which is considered as a disease of outer layers of retina, may be accompanied with a decrease of ganglion cell thickness, so inner layers of retina may be affected.

The efficacy and safety of timolol maleate versus brinzolamide each given twice daily added to travoprost in patients with ocular hypertension or primary open-angle glaucoma.

PURPOSE: To compare the efficacy and safety of timolol maleate 0.5% versus brinzolamide 1% when added to travoprost 0.004% in patients with ocular hypertension or primary open-angle glaucoma. DESIGN: A prospective, double-masked, randomized, active-controlled, parallel comparison. METHODS: Qualified patients at Visit 1 were placed on travoprost dosed every evening for 4 weeks and then were randomized at baseline (Visit 2) to the addition of timolol maleate or brinzolamide each given twice daily. Patients returned to clinic at Week 4 (Visit 3) for a safety visit and Week 12 (Visit 4) for an efficacy visit. At Visits 2 and 4 the intraocular pressure (IOP) was measured at 08:00, 12:00, and 16:00 hours. RESULTS: Ninety-seven patients on brinzolamide had a baseline diurnal IOP of 21.5+/-2.2 mmHg and 95 on timolol maleate had 21.3+/-2.5 mmHg, each added to travoprost. The diurnal mean IOP at Week 12 was 18.1+/-2.7 mmHg for brinzolamide and 18.1+/-3.0 mmHg for timolol maleate (p=0.96). There was no statistical difference found between treatment groups in the absolute level of pressure, or in the reduction in IOP from baseline, at each time point or for the diurnal curve (p>0.05). There was no significant difference for any adverse event between groups (p>0.05), with the most common side effect being conjunctival hyperemia in 15/97 (16%) brinzolamide and 6/95 (6%) timolol treated patients (p=0.06). CONCLUSIONS: This study showed that brinzolamide provides similar safety and efficacy compared to timolol maleate when added to travoprost.

The effects of long-term topical glaucoma medication on conjunctival impression cytology.

Long-term use of topical drugs can induce changes in the conjunctiva and ocular surface. To determine the conjunctival changes resulting from topical glaucoma medication, patients with glaucoma were selected and classified into seven groups, according to the medication received: 24 eyes were treated with betaxolol, 20 eyes with levobunolol, 32 eyes with timolol maleate, 22 eyes with pilocarpine, 52 eyes with beta-blocker and pilocarpine, 34 eyes with beta-blocker and dipivefrin, and 32 eyes with maximum therapy. Patients who were under 18 were excluded, as were those with any history of ocular surgery and other interventions, long-term use of any topically administered medication except glaucoma drugs, and any history or slit-lamp examination evidence of ocular surface disorders. The changes in the conjunctiva of 216 eyes were evaluated by means of ocular surface impression cytology. The medication group showed statistically significant degrees of conjunctival metaplasia when compared to the control group (p < 0.01). The cytological grading was not correlated with age, sex, type of medication, duration of topical treatment or the number of drugs (p > 0.05). Duration of treatment exceeding three months was not correlated with cytological grading. Thus, as far as surgical treatment was concerned, it was concluded that intervention within the first three months after the diagnosis would be most beneficial in the management of glaucoma. The fact that the presence of the preservative benzalkonium chloride was the same in all preparations suggests that it may be the major factor in conjunctival metaplasia.

A comparative clinical trial of mitomycin C and cyclosporin A in trabeculectomy.

This prospective, randomized clinical trial assessed the effects of mitomycin C and cyclosporin A used as antimetabolites in trabeculectomy on the post-operative IOP and success rate. Eighty-six consecutive patients were randomly allocated to three treatment groups. There were 30 patients in the mitomycin C group, 28 in the cyclosporin A group and 28 in the control group. The follow-up periods were different for the three groups and ranged from 6 to 30 months. The treatment groups consisted of primary open-angle glaucoma, closed-angle glaucoma, various secondary glaucomas and prior failed trabeculectomy. There were no significant differences pre-operatively with respect to IOP and number of medications used (p > 0.05). Postoperative IOP was considered to be successfully reduced when it was reduced by more than 25% from baseline or when it was lower than 20 mmHg. According to these criteria, IOP was under control in 90% of the mitomycin C treated eyes, 85.7% of cyclosporin A treated eyes and 71.4% of the control eyes. Postoperatively there was a significant decrease in IOP (p < 0.01) and in the number of medications need to control IOP (p < 0.01) in the mitomycin C and cyclosporin A groups. Post-operative IOP and number of medications in the mitomycin C and cyclosporin A group were similar. Complications encountered in the three groups were similar. There were no serious complications like hypotonus maculopathy. Our study highlights the utility of mitomycin C as an adjunct in glaucoma filtering surgery and indicated that cyclosporin A may also be used as an antimetabolite.