Antonios T. Dimopoulos

24-h Intraocular pressure control with evening-dosed travoprost/timolol, compared with latanoprost/timolol, fixed combinations in exfoliative glaucoma.

PurposeTo evaluate 24-h efficacy of travoprost/timolol fixed combination (TTFC) vslatanoprost/timolol fixed combination (LTFC) in exfoliative glaucoma (XFG).DesignA prospective, single-masked, crossover, active-controlled, randomized 24-h comparison.MethodsAfter up to a 6-week medicine-free period, XFG patients were randomized to either TTFC or LTFC for 3 months, dosed each evening, and then changed to the opposite treatment for another 3 months. At the end of the washout, and both treatment periods, a 24-h intraocular pressure (IOP) curve was measured.ResultsIn total, 40 patients completed the study. The TTFC group showed a lower mean absolute 24-h IOP (18.7±2.6 vs19.6±2.6 mm Hg, P<0.001), maximum IOP (20.5±2.6 vs21.5±2.6 mm Hg, P<0.001) and 24-h IOP range (3.4±1.3 vs4.1±1.6 mm Hg, P=0.01). At individual time points, TTFC showed reduced IOPs compared with LTFC, after a Bonferroni correction, at 1000, 1800, and 2200 hours (P⩽0.04). No statistical differences existed at hours: 0600, 1400, and 0200 (P⩾0.05) and for the minimum IOP (P=0.09).ConclusionsThis study suggests that evening-dosed TTFC may provide greater 24-h IOP reduction, primarily at the 1800 hours time point, compared with LTFC in XFG.

24-hour efficacy of the bimatoprost–timolol fixed combination versus latanoprost as first choice therapy in subjects with high-pressure exfoliation syndrome and glaucoma

Aim To compare the 24-h intraocular pressure (IOP) control obtained with the bimatoprost–timolol fixed combination (BTFC) versus latanoprost in newly diagnosed, previously untreated exfoliation syndrome (XFS) or exfoliative glaucoma (XFG) patients with baseline morning IOP greater than 29 mm Hg. Methods One eye of 41 XFS/XFG patients who met inclusion criteria was included in this prospective, observer-masked, crossover, comparison protocol. All subjects underwent a 24-h untreated curve and were then randomised to either evening administered BTFC or latanoprost for 3 months and then switched to the opposite therapy. At the end of each treatment period, patients underwent a treated 24-h IOP assessment. Results 37 patients completed the trial. At baseline, mean untreated 24-h IOP was 31.1 mm Hg. Mean 24-h IOP with BTFC was significantly lower than with latanoprost (18.9 vs 21.2 mm Hg; p<0.001). Furthermore, BTFC reduced IOP significantly more than latanoprost at every time point, for the mean peak and trough 24-h IOP (p<0.001). There was no difference, however, in mean 24-h IOP fluctuation between the two medications (3.8 with BTFC vs 4.2 with latanoprost; p=0.161). Both treatments were well tolerated and there was no statistically significant difference for any adverse event between them. Conclusions As first choice therapy in high-pressure, at-risk exfoliation patients, BTFC controlled mean 24-h IOP significantly better than latanoprost monotherapy.

Second-line therapy with dorzolamide/timolol or latanoprost/timolol fixed combination versus adding dorzolamide/timolol fixed combination to latanoprost monotherapy

Objective: To evaluate open-angle glaucoma patients, who were insufficiently controlled on latanoprost monotherapy, to determine the 24 h intraocular pressure (IOP) efficacy and safety when changing them to dorzolamide/timolol (DTFC) or latanoprost/timolol fixed combination (LTFC) or adding DTFC. Methods: A prospective, observer-masked, placebo-controlled, crossover, comparison. Consecutive adults with primary open-angle or exfoliative glaucoma who exhibit a mean baseline IOP >21 mm Hg on latanoprost monotherapy were randomised for 3 months to: DTFC, LTFC or DTFC and latanoprost. Patients were then crossed over to the next treatment for periods 2 and 3. At the end of the latanoprost run-in and after each 3-month treatment period, patients underwent 24 h IOP monitoring. Results: 31 patients completed this study. All three adjunctive therapies significantly reduced the IOP at each time point and for the mean 24 h curve, except at 18:00 and 02:00 with DTFC and 02:00 with LTFC. When the three treatments were compared directly, the DTFC and latanoprost therapy demonstrated lower IOPs versus the other treatment groups, including: the mean 24 h pressure, maximum as well as minimum levels and individual time points following a modified Bonferroni correction (p<0.0032). Conclusions: This study showed DTFC, LTFC and the addition of DTFC to latanoprost significantly decrease the IOP compared with latanoprost alone, but the latter therapy regime yields the greatest IOP reduction.

Scanning laser polarimetry in eyes with exfoliation syndrome.

Purpose To compare retinal nerve fiber layer thickness (RNFLT) of normotensive eyes with exfoliation syndrome (XFS) and healthy eyes. Methods Sixty-four consecutive individuals with XFS and normal office-time intraocular pressure (IOP) and 72 consecutive healthy controls were prospectively enrolled for a cross-sectional analysis in this hospital-based observational study. The GDx-VCC parameters (temporal-superior-nasal-inferior-temporal [TSNIT] average, superior average, inferior average, TSNIT standard deviation (SD), and nerve fiber indicator [NFI]) were compared between groups. Correlation between various clinical parameters and RNFLT parameters was investigated with Spearman coefficient. Results The NFI, although within normal limits for both groups, was significantly greater in the XFS group compared to controls: the respective median and interquartile range (IQR) values were 25.1 (22.0–29.0) vs 15.0 (12.0–20.0), p<0.001. In the XFS group, all RNFLT values were significantly lower compared to controls (p<0.001). However, they were all within the normal clinical ranges for both groups: TSNIT average median (IQR): 52.8 (49.7–55.7) vs 56.0 (53.0–59.3) μm; superior average mean (SD): 62.3 (6.7) vs 68.8 (8.2) μm; inferior average mean (SD): 58.0 (7.2) vs 64.8 (7.7) μm, respectively. TSNIT SD was significantly lower in the XFS group, median (IQR): 18.1 (15.4–20.4) vs 21.0 (18.4–23.8), p<0.001. There was no systematic relationship between RNFLT and visual acuity, cup-to-disc ratio, IOP, central corneal thickness, Humphrey mean deviation, and pattern standard deviation in either group. Conclusions Compared to control eyes, polarimetry-determined RNFLT was lower in XFS eyes with normal IOP. Therefore, close monitoring of RNFLT may facilitate early identification of those XFS eyes that convert to exfoliative glaucoma.

Association of POAG risk factors and the Thr377met MYOC mutation in an isolated greek population

PURPOSE To characterize the MYOC genotype correlation with phenotypes in an isolated Greek population with a high incidence of glaucoma. METHODS Five hundred thirty-one villagers were enrolled in the study. Participants underwent a comprehensive ophthalmic examination. All three exons of myocilin were bidirectionally sequenced. Power calculations and measured genotype analysis was conducted using the genetic variance analysis program, SOLAR version 4.2, to account for the relatedness between individuals. RESULTS The participants, 376 of whom were linked in a single 11-generation pedigree, ranged in age from 10 to 95 years with a mean age of 49. Sixty-five individuals had POAG, and 27 of those carried the Thr377Met MYOC mutation. Both peak intraocular pressure and vertical cup-to dis- ratio were significantly associated with the MYOC Thr377Met variant (P = 9 x 10(-14) and P = 9 x 10(-8), respectively), whereas central corneal thickness showed no significant association (P < 0.7). CONCLUSIONS This village had a high frequency of glaucoma, with 12% of the participants aged 10 to 95 years having the disease. In this cohort, the Thr377Met MYOC mutation was significantly associated with both high intraocular pressures and high vertical cup-to-disc ratios. No association was found with central corneal thickness.