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ABSTRACT: Prostaglandin analogs are currently the first-line agents in the medical treatment of glaucoma. Frequently, more than one drug is needed to control intraocular pressure. Beta-blockers, topical carbonic anhydrase inhibitors, and alpha-adrenergic agonists are commonly used in addition to prostaglandin analogs. Topical carbonic anhydrase inhibitors are more effective in lowering intraocular pressure at trough than alpha-adrenergic agonists. Although similarly effective as topical carbonic anhydrase inhibitors during the day, adequate nocturnal intraocular pressure reduction with beta-blockers is controversial. Three fixed combinations of prostaglandins with timolol (0.005% latanoprost with 0.5% timolol, 0.004% travoprost with 0.5% timolol, and 0.03% bimatoprost with 0.5% timolol) are available. Fixed-combination therapy has advantages over multi-drop, multi-bottle therapy in terms of patient convenience and adherence without sacrificing the additive effects of the unfixed combinations. In countries where they are available, fixed combinations of prostaglandins/beta-blockers may become second-line treatment. Fixed and unfixed adjunctive combinations with prostaglandin analogs have demonstrated, in multiple comparative studies, to be effective, but none has been shown to be an ideal combination.
Survey of Ophthalmology 11/2008; 53 Suppl1:S85-92. · 2.35 Impact Factor
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British Journal of Ophthalmology 11/2007; 91(10):1263-4. · 2.90 Impact Factor
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ABSTRACT: To investigate the hypothesis that the pathophysiology for the death of retinal ganglion cells in glaucoma involves excitotoxic effects from elevated concentrations of vitreal glutamate.
Experimental glaucoma was induced in the right eyes of 18 rhesus monkeys by argon laser treatments to the trabecular meshwork. After significant visual field defects and/or typical clinical glaucomatous changes had developed (1.5-13 months), the eyes were removed, and a sample (0.1-0.2 mL) of posterior vitreous was collected. Similar vitreous samples also were collected from eight untreated monkeys. The vitreous samples were analyzed in a masked fashion by high-pressure liquid chromatography in two independent laboratories. Mean levels of vitreal glutamate were determined for the treated and control eyes and differences between groups of eyes were evaluated by Student's t-test.
The mean level (+/- SD) of vitreal glutamate in the eight untreated monkeys was 5.0 +/- 2.0 microM. A similar level of 5.7 +/- 1.8 microM was measured in the untreated eyes of monkeys with experimental glaucoma. In the glaucomatous eyes, the mean concentration of vitreal glutamate was 5.7 +/- 2.6 microM, which was not significantly different from the concentrations in the control eyes.
Vitreal glutamate concentrations were not elevated in eyes with anatomic and functional damage from experimental glaucoma. This finding is in contradiction to previous reports that vitreal glutamate increases to toxic levels and probably contributes to glaucomatous damage of retinal ganglion cells.
Investigative Ophthalmology & Visual Science 09/2002; 43(8):2633-7. · 3.60 Impact Factor
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ABSTRACT: The purpose of this study was to determine whether 5-fluorouracil administered as a single intraoperative dose beneath the conjunctival flap during trabeculectomy in patients with glaucoma would be safe and effective. This prospective case series consists of 43 eyes of 43 consecutive patients who underwent trabeculectomy with intraoperative topical administration of 5-fluorouracil. Surgical outcome and success rate of the procedure were evaluated at a 6-month follow-up period. Success was defined as a postoperative intraocular pressure (IOP) of </=21 mm Hg with a minimum 20% drop in IOP from preoperative levels and one Snellen line or less loss of visual acuity, at the end of 6 months. The overall success rate was 85.4%. Mean IOP was 31.4 +/- 11.4 preoperatively and 15.1 +/- 4.6 postoperatively. The mean number of antiglaucoma medications was reduced from 2.8 +/- 0.9 to 0.4 +/- 0.7. Success rates were 69.2% in eyes with high risk for failure and 92.9% in relatively low-risk eyes. A thin and ischemic bleb was characteristic in the immediate postoperative period and remained so in all successful eyes with the exception of five eyes (11.6%) that developed encapsulated blebs. There were no corneal epithelial complications. Intraoperative 5-fluorouracil application directly to the trabeculectomy site appears to be a safe and effective method. It can be a valuable alternative in glaucoma surgery, but may be less successful in eyes with high risk for failure.
Journal of Glaucoma 01/1994; 3(4):302-7. · 1.78 Impact Factor
