UNLABELLED: PURPOSE : To compare the efficacy and safety of the fixed-dose combination (FDC) of netarsudil 0.02%/latanoprost 0.005% ophthalmic solution (NET/LAT; Roclanda®) with bimatoprost 0.03%/timolol maleate 0.5% (BIM/TIM; Ganfort®) ophthalmic solution in the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT). METHODS: MERCURY-3 was a 6-month prospective, double-masked, randomized, multicenter, active-controlled, parallel-group, non-inferiority study. Patients (≥ 18 years) with a diagnosis of OAG or OHT in both eyes that was insufficiently controlled with topical medication (IOP ≥ 17 mmHg in ≥ 1 eye and < 28 mmHg in both eyes) were included. Following washout, patients were randomized to once-daily NET/LAT or BIM/TIM for up to 6 months; efficacy was assessed at Week 2, Week 4, and Month 3; safety was evaluated for 6 months. Comparison of NET/LAT relative to BIM/TIM for mean IOP at 08:00, 10:00, and 16:00 h was assessed at Week 2, Week 6, and Month 3. Non-inferiority of NET/LAT to BIM/TIM was defined as a difference of ≤ 1.5 mmHg at all nine time points through Month 3 and ≤ 1.0 mmHg at five or more of nine time points through Month 3. RESULTS: Overall, 430 patients were randomized (NET/LAT, n = 218; BIM/TIM, n = 212), and all received at least one dose of study medication. Efficacy analyses were performed at Month 3 on 388 patients (NET/LAT, n = 184; BIM/TIM, n = 204). NET/LAT demonstrated non-inferiority to BIM/TIM, with a between-treatment difference in IOP of ≤ 1.5 mmHg achieved at all time points and ≤ 1.0 mmHg at the majority of time points (six of nine) through Month 3. Mean diurnal IOP during the study ranged from 15.4 to 15.6 mmHg and 15.2 to 15.6 mmHg in the NET/LAT and BIM/TIM groups respectively, with no between-group statistically significant difference. No significant differences were observed in key secondary endpoints. No serious, treatment-related adverse events (AEs) were observed, and AEs were typically mild/moderate in severity. The most common treatment-related AEs were conjunctival hyperemia (NET/LAT, 30.7%; BIM/TIM, 9.0%) and cornea verticillata (NET/LAT, 11.0%; BIM/TIM, 0%). CONCLUSIONS: Once-daily NET/LAT was non-inferior to BIM/TIM in IOP reduction in OAG and OHT, with AEs consistent with previous findings. NET/LAT offers a compelling alternative FDC treatment option for OAG and OHT.
- MeSH
- antihypertenziva škodlivé účinky MeSH
- benzoáty * MeSH
- beta-alanin analogy a deriváty MeSH
- bimatoprost terapeutické užití MeSH
- dvojitá slepá metoda MeSH
- glaukom s otevřeným úhlem * diagnóza farmakoterapie MeSH
- latanoprost škodlivé účinky MeSH
- lidé MeSH
- nitrooční tlak MeSH
- oční hypertenze * diagnóza farmakoterapie MeSH
- oční roztoky MeSH
- prospektivní studie MeSH
- timolol škodlivé účinky MeSH
- tonometrie oční MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
Cíl: Cílem této studie bylo ověřit možné změny konvenčně nediagnostikované nasální části zorného pole u pacientů s diagnózou včasného primárního glaukomu s otevřeným úhlem (PGOÚ) s vysokou tenzí. Materiál a metody: Vyšetření vzdálené nasální části zorného pole bylo provedeno u 30 nemocných (60 očí) s počínajícím PGOÚ (preperimetrické stadium změn). Soubor tvořilo 16 žen (průměrného věku 46,5 let) a 14 mužů (průměrného věku 44,7 let). U všech očí bylo zjištěno glaukomovým programem (rychlý prahový program v rozsahu 50 stupňů nasálně a 22 stupňů temporálně) přístrojem Medmont M700 fyziologické zorné pole. Zraková ostrost byla 1,0 s případnou korekcí menší nebo rovnou ±3 dioptrie, a kromě glaukomového onemocnění neměli jinou oční vadu. Zorné pole bylo následně vyšetřeno stejným přístrojem posunutím fixačního bodu o 40 stupňů temporálně (prostorově adaptabilní program) a současným otočením hlavy o 10 stupňů nasálně. Celkem bylo zahrnuto 89 vyšetřovacích bodů s použitím flicker podnětů a rozsahem 0–120 stupňů nasálně. Výsledky: U všech očí byla zjištěna deprese vzdálené periferie nasální části zorného pole v rozsahu od 50 do 95 stupňů, při normální zorném poli vyšetřeným glaukomovým programem. Závěr: Při normálním zorném poli vyšetřeném rychlým prahovým glaukomovým programem byly u všech nemocných PGOÚ zjištěny změny v distální části nasální periferie zorného pole.
Aim: The aim of this study was to examine possible changes in the conventionally undiagnosed nasal visual field in patients diagnosed with early primary open angle glaucoma. Material and Methods: Examination of the far nasal part of the visual field was performed in 30 patients (60 eyes) with early stage of primary open angle glaucoma (preperimetric stage of changes). The cohort consisted of 16 women (mean age 46.5 years) and 14 men (mean age 44.7 years). In all eyes, the glaucoma program (rapid threshold program of 50 degrees nasally and 22 degrees temporally) was performed with the Medmont M700 instrument to determine the physiological visual field. Visual acuity was 1.0 with a possible correction less than or equal to ±3 diopters and they had no other ocular defect except glaucoma disease. The visual field was subsequently examined with the same instrument by moving the fixation point 40 degrees temporally (spatially adaptive program) and simultaneously turning the head 10 degrees nasally. A total of 89 examination points were included using flicker stimuli and a range of 0–120 degrees nasally. Results: The far nasal limit of the visual field reached 100° in 13.33% of eyes, 105° in 20% of eyes and up to 110° in 66.67% of eyes. Conclusion: In all eyes, depression of the distal periphery of the nasal part of the visual field was found to range from 50 to 95 degrees, with a normal visual field examined by the glaucoma program.
- MeSH
- časná diagnóza MeSH
- glaukom s otevřeným úhlem diagnóza MeSH
- glaukom * diagnóza MeSH
- lidé MeSH
- optická koherentní tomografie MeSH
- testy zrakového pole metody MeSH
- zraková pole MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- klinická studie MeSH
- MeSH
- chirurgie operační metody MeSH
- diferenciální diagnóza MeSH
- farmakoterapie metody MeSH
- glaukom s otevřeným úhlem diagnóza terapie MeSH
- glaukom s uzavřeným úhlem diagnóza etiologie terapie MeSH
- glaukom * diagnóza klasifikace terapie MeSH
- laserová terapie metody MeSH
- lidé MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PRCIS: Deep sclerectomy (DS) with the Esnoper Clip drainage implant in patients with uncontrolled primary open angle glaucoma (POAG) achieved a complete success rate of 87.2% at the 1-year follow-up. PURPOSE: To investigate the efficacy and safety of DS followed by Esnoper Clip implantation in patients with uncontrolled POAG. MATERIALS AND METHODS: In a prospective, consecutive, interventional study, we investigated 39 eyes of 35 patients with uncontrolled POAG who underwent DS with Esnoper Clip implantation. Complete ophthalmologic examinations including corrected visual acuity and intraocular pressure (IOP), were performed preoperatively, and at 1 day, at 1 week as well as at 1, 3, 6, 9, and 12 months postoperatively. Moreover, any goniopunctures and glaucoma medications required postoperatively were noted. RESULTS: The mean preoperative IOP was 20.8±5.2 mm Hg and it decreased to 13.9±3.1 mm Hg at 1 year postoperatively ( P <0.001). The number of glaucoma medications decreased from 2.9±0.7 preoperatively to 0.3±0.8 after 1 year ( P <0.001). The complete success rate (IOP≤21 mm Hg without glaucoma medication) and the qualified success rate (IOP ≤21 mm Hg with or without glaucoma medication) were 87.2% and 94.9%, respectively. Goniopuncture was performed in 33.3% of cases. No significant corrected visual acuity changes were registered at the final follow-up. Perioperative complications consisted of 3 micro-perforations of the trabeculo-descemet membrane. Postoperative complications included: hyphema (6 eyes), hypotony (6 eyes), shallow anterior chamber (3 eyes), choroidal detachment (4 eyes)-all of which were resolved without surgical intervention during the first postoperative month-and conjunctival dehiscence, which required resuture (2 eyes). CONCLUSION: Deep sclerectomy with the Esnoper Clip implant was safe and effectively lowered IOP in patients with uncontrolled POAG.
PURPOSE: To investigate the ocular surface inflammation in patients with primary open angle glaucoma and ocular hypertension by analyzing tears and to compare findings with healthy controls. METHODS: Observational case-control study. Tear samples were collected by 5 μl microcapillary tube from 24 patients with glaucoma treated by antiglaucoma drops, 9 non-treated patients with ocular hypertension and 45 healthy controls. Tears were analyzed from right eye by multiplex Bio-Plex system for the presence of 6 cytokines: IL1β, IL10, IL4, IFNγ, MIF and VEGF. RESULTS: Significantly higher concentrations of IL1β and IL10 (glaucoma or ocular hypertension vs. healthy controls, p < 0.0001), VEGF (glaucoma vs. ocular hypertension, p < 0.05; ocular hypertension vs. healthy controls, p < 0.02) and MIF (glaucoma vs. healthy controls, p < 0.03) were detected in patients' tears. Both patient groups have activated to a significantly lower extent the Th1 pathway represented by IFNγ than Th2 pathway represented by IL10 (p < 0.001) and, at the same time, the IFNγ/IL4 ratio was significantly increased in healthy controls (p < 0.001) and patients with ocular hypertension (p < 0.02) compared to glaucoma individuals. CONCLUSION: This study shows that secretion of inflammation-related cytokines by conjunctival cells is increased in both, glaucoma and ocular hypertension patients and can be detected in their tears. Nevertheless, data indicates stronger ocular surface inflammation in non-treated follow-up patients diagnosed with ocular hypertension than in glaucoma subjects treated by antiglaucoma drops.
- MeSH
- antihypertenziva terapeutické užití MeSH
- cytokiny metabolismus MeSH
- glaukom s otevřeným úhlem * MeSH
- glaukom * farmakoterapie MeSH
- interleukin-10 metabolismus MeSH
- interleukin-4 metabolismus MeSH
- lidé MeSH
- nitrooční tlak MeSH
- oční hypertenze * MeSH
- oční roztoky MeSH
- slzy metabolismus MeSH
- studie případů a kontrol MeSH
- vaskulární endoteliální růstový faktor A metabolismus MeSH
- zánět metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Aim of the study: To compare the intraocular pressure (IOP) lowering effect and postoperative complications between primary augmented trabeculectomy and glaucoma drainage device (GDD) implantation as primary surgical intervention in patients with juvenile-onset open angle glaucoma (JOAG). Patients and Methods: A retrospective review study involving 20 eyes that underwent primary augmented trabeculectomy with mitomycin (MMC) and 10 eyes GDD implantation in 3 tertiary centres in Malaysia between 1 January 2013 and 31 December 2019. They were followed up for at least 12 months postsurgical intervention. Intraocular pressure (IOP), number of topical IOP lowering medication and complications were evaluated at 1, 3, 6 and 12 months post-intervention. Based on the IOP, the success was divided into complete and partial success, and failure. IOP and postsurgical complications were compared using the Repetitive Measure Analysis of Variance (RM ANOVA) and the Pearson chi-square test. Results: Both methods were effective in lowering the IOP. Eyes with primary augmented trabeculectomy have significant lower IOP compared to GDD implantation (p = 0.037). There was a higher incidence of postoperative hypotony (30%) in the trabeculectomy group. There was also a significant reduction of mean number of topical pressure-lowering drugs required postoperatively (p = 0.015). Complete success was achieved in 100% of eyes with trabeculectomy and 67% in GDD implantation (p = 0.047). Conclusions: Primary augmented trabeculectomy and GDD implantation are good surgical options for the treatment of JOAG. Both methods provide IOP lowering at 1 year. However, trabeculectomy provides better pressure lowering, compared to GDD implantation in patients with JOAG.
Cíle: Mutace v genu myocilin (MYOC) vedou k dysfunkci trámčiny a mají tak vliv na etiopatogenezi primárního glaukomu s otevřeným úhlem (PGOÚ). Cílem práce bylo charakterizovat a popsat klinické nálezy ve dvou českých rodinách s PGOÚ vzniklým na podkladě patogenních variant v tomto genu. Materiál a metody: Příslušníci dvou rodin s výskytem PGOÚ podstoupili komplexní oftalmologické vyšetření. U probanda z první rodiny jsme provedli přímé sekvenování tří nejčastějších mutací v genu MYOC a u probanda z druhé rodiny pak exomové sekvenování. Ostatní rodinní příslušníci byli cíleně testováni pomocí přímého sekvenování. Výsledky: Celkem jsme vyšetřili 10 jedinců s diagnózou PGOÚ ve věku 20–70 let (průměr 32,2 let, SD ±10,9 let). Osm z nich vykazovalo obraz pokročilé glaukomové neuropatie se závažnými změnami vrstvy nervových vláken. K manifestaci PGOÚ došlo u šesti jedinců již ve třetí dekádě života, u ostatních čtyř pak v průběhu čtvrté dekády života. U osmi z 10 pacientů bylo nutné přikročit k provedení filtrační operace. Operace proběhla v rozmezí 1–7 let od stanovení diagnózy, u většiny však byla provedena do dvou let od stanovení diagnózy. V první rodině byla u postižených členů nalezena v MYOC varianta c.1099G>A p.(Gly367Arg), ve druhé rodině pak c.1440C>A p.(Asn480Lys), obě v heterozygotním stavu. Změny byly vyhodnoceny jako patogenní. Závěr: Naše studie jako první popisuje u českých pacientů mutace v genu MYOC způsobující PGOÚ. Genetické testování lze u této diagnózy doporučit především u jedinců s časnou manifestací a pozitivní rodinnou anamnézou. Nositelé patogenních variant genu MYOC mají celoživotní riziko vzniku PGOÚ více než 50% a průběh jejich onemocnění je často agresivnější, vyžadující chirurgickou intervenci k trvalé kompenzaci nitroočního tlaku.
Aim: Mutations in the myocilin gene (MYOC) cause trabecular dysfunction and thus are involved in the pathogenesis of primary open-angle glaucoma (POAG). The aim of this study was to characterize and describe the clinical findings in two Czech families with POAG due to pathogenic variants in the MYOC gene. Material and methods: Members of the two families affected by POAG underwent complete ophthalmological examination. In the proband from the first family, a direct sequencing of the three most frequent mutations in the MYOC gene was performed, and in the proband from the second family, an exome sequencing was performed. Other family members underwent targeted tests using direct sequencing. Results: In total, 10 individuals diagnosed with POAG aged 20–70 years (mean 32.2 years, SD ±10,9 years) were examined. Eight of them showed advanced glaucomatous neuropathy with severe changes in the retinal nerve fiber layer. Clinical signs of POAG were present in six individuals in the third decade of life already; another four developed POAG during the fourth decade of life. Eight out of 10 patients had to undergo filtration surgery. Surgery was performed within 1 to 7 years of diagnosis, but mostly was performed within 2 years of glaucoma diagnosis. In the first family, MYOC variant c.1099G>A p.(Gly367Arg) was shown in the affected family members; in the second family MYOC variant c.1440C>A p.(Asn480Lys), both in heterozygous state. The changes were assessed as pathogenic. Conclusion: Our study is the first to describe mutations in the MYOC gene causing POAG in Czech patients. Genetic testing may be recommended for this diagnosis, especially in individuals with early presentation and a positive family history. Carriers of pathogenic variants of the MYOC gene have a lifetime risk of developing POAG of more than 50% and the course of their disease is often more aggressive, requiring surgical intervention to permanently control the intraocular pressure.
- Klíčová slova
- myocilin,
- MeSH
- cytoskeletální proteiny MeSH
- diagnostické techniky oftalmologické MeSH
- genetické testování MeSH
- glaukom s otevřeným úhlem * diagnóza etiologie genetika MeSH
- glykoproteiny MeSH
- lidé MeSH
- mutace MeSH
- oční proteiny MeSH
- věk při počátku nemoci MeSH
- výzkum MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- MeSH
- chirurgie operační metody MeSH
- diferenciální diagnóza MeSH
- farmakoterapie metody MeSH
- glaukom s otevřeným úhlem diagnóza terapie MeSH
- glaukom s uzavřeným úhlem diagnóza etiologie terapie MeSH
- glaukom * diagnóza klasifikace terapie MeSH
- laserová terapie metody MeSH
- lidé MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Hypertensive glaucoma (HTG) causes damage to the retinal ganglion cells and eventually to the entire visual pathway due to high intraocular pressure (IOP). However, increased IOP will also affect the vessel density (VD) of the posterior pole of the eye and the related retinal ganglion nerve fibres (RNFL). In normotensive glaucoma (NTG), the retinal ganglion cells are relatively intact. The pathology is at the level of ganglion fibres. The unanswered question is what has altered ganglion cell fibres at the level of the retina and optic nerve head in NTG? AIM: The aim of this study was to determine whether there is a correlation between the retinal nerve fibre layer (RNFL) and vessel density (VD) at the same altitudinal half of the retina and the sum of sensitivities of the contralateral half of the visual field of the same eye in hypertensive and normotensive glaucoma (NTG). METHODS: Our group included 20 patients with HTG and 20 patients with NTG. The Pearson's correlation coefficient r was used for evaluation of the relationship of the peripapillary RNFL and VD, visual field (using the fast threshold glaucoma program) as the sum of sensitivities in apostilbs (asb) to the extent of 0-22 degrees. The results of sensitivity were compared with the RNFL and VD of the contralateral altitudinal half of the retina in the same eye. RESULTS: In the HTG group there was a moderate relationship between RNFL and VD (both hemifields), but no relationship between RNFL and VF. VD SH and VF IH showed weak correlation and VD IH and VF SH showed no correlation. In patients with NTG, we found a strong correlation between RNFL and VD (both hemifields), between VD SH and VF IH a moderate correlation, between VD IH and VF SH also a moderate correlation and a weak correlation between RNFL and VF. CONCLUSION: By comparing the RNFL and VD at the same altitudinal halves of the retina, we found a moderate correlation in HTG and a strong correlation in NTG. We found no or a weak correlation between VD and VF in HTG. In NTG the relationship between VD and VF showed a strong correlation. These findings reveal the differences in the diagnostic groups.
- MeSH
- angiografie MeSH
- glaukom s otevřeným úhlem * MeSH
- glaukom * MeSH
- lidé MeSH
- nitrooční tlak MeSH
- optická koherentní tomografie MeSH
- zraková pole MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: To measure parameters of the cardiac cycle-induced pulsatile light absorption signal (plethysmography signal) of the optic nerve head (ONH) and to compare parameters between normal subjects and patients with different stages of glaucoma. PATIENTS AND METHODS: A recently developed video ophthalmoscope was used to acquire short video sequences (10 s) of the ONH. After image registration and trend correction, the pulsatile changing light absorption at the ONH tissue (excluding large vessels) was calculated. The changing light absorption depends on the pulsatile changing blood volume. Various parameters, including peak amplitude, steepness, time-to-peak, full width at half maximum (FWHM), and pulse duration, were calculated for averaged individual pulses (heartbeats) of the plethysmography signal. This method was applied to 19 healthy control subjects and 91 subjects with ocular hypertension, as well as different stages of primary open-angle glaucoma (17 subjects with ocular hypertension, 24 with preperimetric glaucoma, and 50 with perimetric glaucoma). RESULTS: Compared to the normal subjects, significant reductions (p < 0.001) in peak amplitude and steepness were observed in the group of perimetric glaucoma patients, but no significant difference was found for time-to-peak, FWHM, and pulse duration. Peak amplitude and steepness showed high correlations with RNFL thickness (p < 0.001). CONCLUSIONS: The presented low-cost video-ophthalmoscope permits measurement of the plethysmographic signal of the ONH tissue and calculation of different blood flow-related parameters. The reduced values of the amplitude and steepness parameters in perimetric glaucoma patients suggest decreased ONH perfusion and blood volume. This outcome is in agreement with results from other studies using OCT angiography and laser speckle flowgraphy, which confirm reduced capillary density in these patients. Registration site: www.clinicaltrials.gov , Trial registration number: NCT00494923.
- MeSH
- discus nervi optici * MeSH
- glaukom s otevřeným úhlem * MeSH
- glaukom * diagnóza MeSH
- lidé MeSH
- nitrooční tlak MeSH
- optická koherentní tomografie MeSH
- pletysmografie MeSH
- zraková pole MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
