Increased malondialdehyde concentration and reduced total antioxidant capacity in aqueous humor and blood samples from patients with glaucoma.

PURPOSE: To evaluate the levels of malondialdehyde (MDA) and total antioxidant capacity (TAC) in the blood and aqueous humor of glaucomatous and nonglaucomatous patients. To measure the adenosine triphosphate/adenosine diphosphate/adenosine monophosphate (ATP/ADP/AMP) concentration as a biomarker of the blood energy charge potential. METHODS: We examined 40 consecutive patients with primary open-angle glaucoma scheduled for cataract surgery. Twenty-six age-matched subjects scheduled for cataract surgery were enrolled as a control group. Blood and aqueous humor samples were collected at the time of surgery. MDA concentrations and blood nucleotides were measured with high-performance liquid chromatography. The TAC of the samples was estimated with the oxygen-radical absorbance capacity method. RESULTS: Blood and aqueous humor MDA levels in glaucoma patients (respectively, 0.976±0.370 and 0.145±0.065 µmol/ml) were significantly increased (p<0.001 for both) over those of the control group (respectively, 0.454±0.395 and 0.060±0.039 µmol/ml). In contrast, the control group presented significantly higher TACs than did the glaucoma group in both the blood (control: 2.681±1.101 and glaucoma: 1.617±0.674 µmol Trolox Equi/g; p<0.001) and aqueous humor (control: 0.963±0.302 and glaucoma: 0.788±0.346 µmol Trolox Equi/g; p=0.039). The control group (0.869±0.037) exhibited statistically significant (p<0.001) higher values of blood adenosine triphosphate/adenosine diphosphate (ATP-ADP) levels than did the glaucoma group (0.791±0.037). CONCLUSIONS: Our data further support the hypothesis that oxidative stress and decreased antioxidant defenses are involved in glaucoma. High-performance liquid chromatography appears to be an effective and sensitive method to detect altered levels of oxidative stress markers in glaucoma patients.

Efficacy of Timolol 0.1% Gel and a Prostaglandin Analog in an Unfixed Combination Compared to the Corresponding Fixed Combinations.

PURPOSE: To investigate the intraocular pressure (IOP) reduction with prostaglandin analogs (PGAs)-timolol fixed combinations versus the unfixed combination of the same PGAs and timolol 0.1% in gel-forming carbomer. METHODS: Patients with primary open-angle glaucoma (POAG) receiving for at least 4 weeks the fixed combinations of PGA-timolol, administered once a day in the evening (0.005% latanoprost with 0.5% timolol, 0.004% travoprost with 0.5% timolol, 0.03% bimatoprost with 0.5% timolol) were switched to an unfixed combination of the same PGA (once a day in the evening) with timolol 0.1% in gel-forming carbomer (once a day in the morning) for at least 4 weeks. The primary endpoint was to compare efficacy of fixed vs unfixed combinations in lowering IOP. The effects of both regimens on short-term IOP fluctuations were also assessed. RESULTS: A total of 32 patients (64 eyes) fulfilled inclusion criteria: 17 patients received latanoprost-timolol fixed combination, 9 travoprost-timolol fixed combination, 6 bimatoprost-timolol fixed combination. For all considered time periods each unfixed combination induced an IOP reduction significantly higher than the corresponding fixed combination (paired t test: p<0.05 in all measurements). The diurnal IOP reduction was significantly higher during the unfixed combinations (p<0.001). Unfixed combinations significantly decreased IOP diurnal fluctuations and increased the percentage of patients with daily IOP fluctuation ≤2 mm Hg. CONCLUSIONS: In this pilot study, PGA and timolol seems to be more effective in POAG treatment when administered as unfixed combinations, reducing both IOP and daily fluctuations. The once a day timolol 0.1% gel-forming carbomer may be a valuable option in PGA-timolol unfixed combination regimen.

Autologous conjunctival epithelium transplantation and scleral patch graft for postlensectomy wound leakage in Marfan syndrome.

PURPOSE: We report a case of woman with Marfan syndrome and longstanding postlensectomy scleral wound dehiscence. METHODS: A 34-year-old woman with Marfan syndrome who underwent lensectomy 20 years ago had conjunctival leakage with chronic hypotony and conjunctival cystic degeneration secondary to scleral wound dehiscence. Presentation, clinical evaluation, and particular treatment with autologous cultivated conjunctival epithelium transplantation and scleral patch graft are described. RESULTS: A 6-month follow-up confirmed complete epithelization of the ocular surface and absence of leaking from the wound with normal intraocular pressure. CONCLUSIONS: Transplantation of autologous cultivated conjunctival epithelium appears to be a valid strategy in the treatment of ocular disease requiring extensive excision of the conjunctiva.

Lipid peroxidation and total antioxidant capacity in vitreous, aqueous humor, and blood samples from patients with diabetic retinopathy.

PURPOSE: To evaluate levels of malondialdehyde and the total antioxidant capacity (TAC) in the blood, aqueous humor, and vitreous bodies of diabetic and nondiabetic patients. We also measured the blood energy charge potential (ECP). METHODS: We examined 19 patients with type 2 diabetes mellitus and diabetic retinopathy. Ten were scheduled for cataract surgery and pars plana vitrectomy because of proliferative diabetic retinopathy (PDR). The other nine, with mild nonproliferative PDR (NPDR), and fourteen nondiabetic, age-matched subjects enrolled as a control group were scheduled for cataract surgery and vitrectomy because of epiretinal membranes. Blood, aqueous humor and vitreous body samples were collected at the time of surgery. Malondialdehyde concentrations and blood ECP were measured with high-performance liquid chromatography. The TAC of the samples was estimated with the oxygen radical absorbance capacity method. RESULTS: The level of blood and vitreous malondialdehyde in the PDR group was significantly higher compared to controls and to NPDR patients. PDR patients also had lower levels of TAC at the vitreous body and aqueous humor level, but not at the blood level, compared to controls and with NPDR patients. In all diabetic patients, the blood ECP values were significantly lower, compared to control subjects. CONCLUSIONS: Our data support the hypothesis that oxidative stress and the decrease of antioxidant defenses are associated with the progression of diabetic retinopathy to its proliferative form. Antioxidant supply may have the effect of correcting oxidative stress and inhibiting disease progression.

Acute bilateral angle-closure glaucoma and choroidal effusion associated with acetazolamide administration after cataract surgery.

We present an interventional case report of a 76-year-old man who developed bilateral angle-closure glaucoma with extensive choroidal detachment following administration of oral acetazolamide immediately after routine cataract extraction and intraocular lens implantation. Rapid clinical improvement occurred after acetazolamide was stopped and high-dose intravenous steroid therapy was given. Although extremely rare, this adverse effect should be considered in patients who develop acute bilateral angle-closure glaucoma and choroidal effusion after cataract surgery.

A rare case report of Loa loa ocular filariasis.

PURPOSE: We report a case of ocular worm treated surgically and confirmed by microbiological identification. METHODS: A 33-year-old Swiss woman presented to the ophthalmic unit, complaining of pain and foreign body sensation in the left eye. Slit-lamp examination disclosed a subconjunctival amber -colored cord in the conjunctival fornix. Presentation, clinical and histopathologic evaluation, and treatment are described. RESULTS: At the time of surgery, an alive and still intact worm was extracted through conjunctival incision. Histopathology confirmed the presence of filariasis. CONCLUSIONS: As the flow of immigrants from endemic areas of Europe increases, ocular manifestation of loiasis is becoming more frequent and ophthalmologists need to be aware of this diagnosis.

Intimal-type primary sarcoma of the thoracic aorta: an unusual case presenting with left arm embolization.

A case of intimal-type primary sarcoma of the thoracic aorta with unusual left arm embolization is reported.