Ocular hypotensive effects of topically administered agmatine in a chronic ocular hypertensive rat model.

Agmatine, a primary polyamine and potential neuromodulator, exhibits a high affinity to the alpha2-adrenergic receptor as well as imidazoline receptors. As alpha2-adrenergic receptor agonists display positive ocular hypotensive effects, we assessed whether agmatine effectively lowers intraocular pressure (IOP) using a chronic ocular hypertensive rat model. We raised IOP in unilateral eyes of Sprague-Dawley rats by cauterizing three episcleral veins per eye. Four weeks later, we topically administered 10(-3) M agmatine solution 4 times a day for 6 consecutive weeks. After confirming the recovery of IOP to pretreatment level at 13 weeks after cauterization, the retinal ganglion cells (RGCs) were retrogradely labeled and counted. Eyes subjected to episcleral vein cauterization (EVC) demonstrated significant increases in IOP (48.39% increase over baseline IOP), and the elevated IOP was well maintained until 12 weeks. Topically administered agmatine powerfully lowered IOP to 30.29% of its pretreatment level, and the associated washout period was about two weeks. EVC was associated with a 55.44% loss of RGCs in the control group, but agmatine appeared to attenuate this RGC loss to 18.65%. Overall, topically administered agmatine appeared to effectively lower IOP and rescue RGCs in a chronic ocular hypertensive rat model. Although the mechanism underlying these effects is not yet established, it is possible that agmatine offers a powerful new ocular hypotensive agent for eyes with chronic ocular hypertension and/or glaucoma.

Influence of topical bimatoprost on macular thickness and volume in glaucoma patients with phakic eyes.

BACKGROUND: In light of concern about the possible relation between the extensive clinical use of prostaglandin analogues and the development of retinal disorders such as cystoid macular edema, this study investigated the influence of topical application of bimatoprost 0.03% on macular thickness and volume in glaucoma patients with phakic eyes. METHODS: A total of 40 eyes in 22 patients with primary open-angle glaucoma or normal-tension glaucoma were evaluated in this study. Optical coherence tomography images were taken before initiation of bimatoprost application and after 1, 2, and 3 months of treatment. In addition, best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured, and contrast sensitivity tests and fundus examinations were performed. Changes in various parameters, including macular thickness and volume, were analyzed. RESULTS: BCVA and contrast sensitivity did not change from baseline over the treatment period. IOP declined by 20% to 25% from baseline for 1 month before stabilizing. Macular thickness and volume did not increase significantly during the 3 months. INTERPRETATION: Topical application of bimatoprost does not induce clinical or structural changes in the macula, at least in glaucoma patients with phakic eyes. Moreover, bimatoprost effectively lowered IOP without causing macular disorders such as cystoid macular edema.

Comparison between indices of Humphrey matrix and Humphrey perimetry in early glaucoma patients and normal subjects.

We compared visual field indices calculated by Humphrey matrix perimetry (HMP) and Humphrey perimetry (HP) in 62 early glaucoma patients and 587 normal subjects. Reliability indices, except for the false positive rate, were smaller when using HMP. Mean deviation (MD) and pattern standard deviation (PSD) calculated by HMP correlated with those by HP, but MD by HMP showed larger defects in early glaucoma patients. Thus, HMP might be more sensitive for detecting glaucomatous visual field loss.

Long-term intraocular pressure control of trabeculectomy and triple procedure in primary open angle glaucoma and chronic primary angle closure glaucoma.

To evaluate the long-term intraocular pressure (IOP) control of trabeculectomy and triple procedure (cataract extraction by phacoemulsification, intraocular lens implantation and trabeculectomy), 1,542 eyes of 900 patients with primary open angle glaucoma (POAG) or chronic primary angle closure glaucoma (CPACG) were included. When success was defined as an IOP reduction of at least 30% from baseline, with or without antiglaucoma medications, the overall probability of success of trabeculectomy and triple procedure was 0.613 and 0.733 at 15 years, respectively. The success probability of trabeculectomy and triple procedure in reducing IOP below 18 mm Hg was 0.748 and 0.825 at 15 years, respectively. In POAG and CPACG patients, trabeculectomy and triple procedure were effective in reducing IOP for up to 15 years after surgery.

Early glaucoma detection using the Humphrey Matrix Perimeter, GDx VCC, Stratus OCT, and retinal nerve fiber layer photography.

PURPOSE: To compare the effectiveness of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and retinal nerve fiber layer (RNFL) photography using the Heidelberg Retina Angiograph 1 (HRA1) for early glaucoma detection. DESIGN: Cross-sectional comparative study. PARTICIPANTS: Seventy-two primary open-angle glaucoma patients with early-stage visual field defects and 48 healthy controls were included. METHODS: Measurements using Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1, as well as standard automated perimetry, were obtained. We constructed receiver operating characteristic (ROC) curves for all available parameters and calculated the area under the ROC curves (AUC) to seek the best discriminating parameter of each test. Subsequently, the ROC curves were calculated for the combinations of the best discriminating parameters of each test to seek the most effective combination for early glaucoma detection. MAIN OUTCOME MEASURE: The AUC for various parameters of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1. RESULTS: The AUCs of Humphrey Matrix perimetry, GDx VCC, Stratus OCT, and RNFL photography using HRA1 with the best discriminating parameter were 0.990, 0.906, 0.794, and 0.751, respectively. The AUC of the following best combination was 0.972, more than 5 points depressed below the level of 5% on the pattern deviation plot from Humphrey Matrix perimetry, and the nerve fiber indicator was larger than 20 from GDx VCC. CONCLUSIONS: The AUC of the Humphrey Matrix perimetry was greater than that of the GDx VCC, Stratus OCT, and RNFL photography using HRA1.

Brimonidine 0.2% versus brimonidine Purite 0.15%: prophylactic effect on iop elevation after Nd:YAG laser posterior capsulotomy.

AIMS: The aim of this study was to compare the prophylactic effect of brimonidine 0.2% versus brimonidine Purite 0.15% on intraocular pressure (IOP) increase after Nd:YAG laser posterior capsulotomy. METHODS: In this prospective, double-masked, randomized, controlled study, 106 patients (106 eyes) who underwent Nd:YAG laser posterior capsulotomy were allocated to a brimonidine 0.2% group (35 eyes), a brimonidine Purite 0.15% group (36 eyes), or a vehicle group (35 eyes). One (1) drop of brimonidine 0.2%, brimonidine Purite 0.15%, or vehicle was instilled 1 h preoperatively and 1 drop immediately after Nd:YAG laser posterior capsulotomy. IOPs were measured preoperatively and at 1, 2, 3, and 24 h postoperatively. RESULTS: Decreases in IOP from baseline ranged from 2.3 to 2.7 mmHg in the brimonidine 0.2% group and 2.2-2.5 mmHg in the brimonidine Purite 0.15% group (P < 0.05), whereas the vehicle group exhibited a rise in IOP. IOP elevations of less than 5 mmHg occurred in 22.9% of patients in the brimonidine 0.2% group, 27.8% in the brimonidine Purite 0.15% group, and 48.6% in the vehicle group. Spikes of IOP greater than 10 mmHg occurred in 2.9% of patients in the brimonidine 0.2% group, 2.8% in the brimonidine Purite 0.15% group, and 8.6% in the vehicle group. The incidence of IOP elevation was not statistically significant between the brimonidine 0.2% and the brimonidine Purite 0.15% groups (P < 0.05). CONCLUSIONS: Brimonidine 0.2% and brimonidine Purite 0.15% have similar efficacy in the prevention of IOP elevation after Nd:YAG laser posterior capsulotomy.

Anterior transposition of the inferior oblique muscle for a snapped inferior rectus muscle following functional endoscopic sinus surgery.

A 55-year-old woman was referred with a 4-month history of diplopia following functional endoscopic ethmoidectomy for chronic sinusitis. She had right hypertropia of 14 prism diopters in the primary position that increased to 30 prism diopters in down gaze. Her right eye showed a moderate limitation of motion in down gaze. Orbital imaging demonstrated a snapped right inferior rectus muscle. The inferior oblique muscle was transposed as an initial treatment for the snapped inferior rectus muscle. After surgery, the patient was orthophoric and obtained fusion in the primary position.