Jacob T. Wilensky

Laser Therapy for Open Angle Glaucoma

Fort-five phakic eyes with open angle glaucoma received argon laser therapy to the trabecular meshwork (laser goniotherapy). The average IOP dropped from 27.5 to 20.3 mm Hg in 22 eyes that were followed up for seven to fourteen months. Tonographic data obtained from 13 eyes prior to and approximately one month after laser treatment demonstrated a 50% increase in the facility of aqueous outflow. Several eyes experienced hypertensive episodes following treatment, in which the IOP increased as high as 60 mm Hg on one occasion. Two eyes developed prolonged uveitis with peripheral anterior synechiae formation. Laser goniotherapy appears to be a beneficial mode of therapy for open angle glaucoma in many patients. Longer follow-up is needed, however, and its role in secondary and aphakic glaucomas needs to be defined.

ALO 2145 Reduces the Intraocular Pressure Elevation after Anterior Segment Laser Surgery

The effect of an alpha adrenergic agonist, ALO 2145 (para-amino-clonidine [PAC]), was examined in a double-masked, multicenter study on the postoperative intraocular pressure (IOP) elevation after laser surgery in 165 patients (83 trabeculoplasty, 36 iridotomy, and 46 capsulotomy). One drop of 1.0% ALO 2145 or vehicle was instilled 1 hour before and immediately after laser surgery. The mean IOP increase in the ALO 2145-treated group was lower (P less than 0.05) than in the placebo group at each of the first three postoperative hours. Overall, 18% of placebo-treated eyes experienced IOP increases greater than or equal to 10 mmHg as compared with 4% of ALO 2145-treated eyes (P less than 0.003). Ocular and systemic side effects were minimal and did not differ between the treatment groups. ALO 2145 safely and effectively reduced the incidence and magnitude of potentially harmful IOP elevations after anterior segment laser surgery.

MK-507 versus Sezolamide: Comparative Efficacy of Two Topically Active Carbonic Anhydrase Inhibitors

Topical carbonic anhydrase inhibitors MK-507 and sezolamide hydrochloride (previously known as MK-417) were compared in a double-masked, randomized, placebo-controlled study in 82 patients with bilateral primary open-angle glaucoma or ocular hypertension. MK-507 was given every 8 or 12 hours, sezolamide every 8 hours, or placebo every 8 or 12 hours for 4 days. Both drugs lowered intraocular pressure (IOP) substantially. MK-507 was somewhat more active than sezolamide, with a peak mean IOP reduction of 26.2% for MK-507 versus 22.5% for sezolamide, although the difference between the treatments was not statistically significant. These drugs may have potential in the treatment of glaucoma.

Influence of the Number of Laser Burns Administered on the Early Results of Argon Laser Trabeculoplasty

We conducted a prospective, randomized, double-masked study to examine the influence of the number of burns administered on intraocular pressure after argon laser trabeculoplasty. Each of 40 patients with open-angle glaucoma had 50 burns placed over one half the trabecular meshwork (Group 1, 20 patients) or 100 burns placed over the entire trabecular meshwork (Group 2, 20 patients). There was no significant difference between the mean intraocular pressure decreases in Group 1 (-9.20 +/- 6.43 mm Hg) and Group 2 (-6.95 +/- 5.74 mm Hg) after two months (P less than .25). In each group, the intraocular pressure was lowest after two months in those patients in whom it was not increased during the immediate postoperative period (Group 1, P less than .006; Group 2, P less than .07). Because the changes in intraocular pressure were statistically similar in the two groups and because patients receiving only 50 burns may have fewer complications, administering 50 laser burns to one half the trabecular meshwork appears to be the better choice for an initial procedure.

The Use of Dorzolamide and Pilocarpine as Adjunctive Therapy to Timolol in Patients with Elevated Intraocular Pressure

PURPOSE To report the results of two studies on the use of dorzolamide as adjunctive therapy to timolol in patients with elevated intraocular pressure (IOP). In the larger study, the additive effect of dorzolamide administered twice daily also was compared with 2% pilocarpine. METHODS Both studies were parallel, randomized, double-masked, placebo-controlled comparisons. In the pilot study, 32 patients received 0.5% timolol twice daily plus either 2% dorzolamide twice daily or placebo twice daily for 8 days. In the Pilocarpine Comparison Study, 261 patients received 0.5% timolol twice daily plus 0.7% dorzolamide twice daily, 2% dorzolamide twice daily, 2% pilocarpine four times daily, or placebo (twice daily or 4 times daily) for 2 weeks. Patients then entered a 6-month extension period and received 0.5% timolol twice daily plus either 0.7% dorzolamide twice daily, 2% dorzolamide twice daily, or 2% pilocarpine four times daily. RESULTS In the pilot study, after 8 days, additional mean percent reductions in IOP for 2% dorzolamide and placebo were 17% and 3% at morning trough and 19% and 2% at peak, respectively. In the Pilocarpine Comparison Study, after 6 months, additional mean percent reductions in IOP (morning trough) were 9%, 13%, and 10% for 0.7% dorzolamide, 2% dorzolamide, and 2% pilocarpine, respectively. Patients receiving 2% pilocarpine had the highest rate of discontinuation due to a clinical adverse experience, and the use of dorzolamide was not associated with systemic side effects commonly observed with the use of oral carbonic anhydrase inhibitors. CONCLUSION Dorzolamide twice daily was effective and well tolerated by the patients in these studies as adjunctive therapy to timolol. The larger study demonstrated that both concentrations of dorzolamide produce similar IOP-lowering effects to 2% pilocarpine.

Effects of Corticosteroid Pretreatment on Argon Laser Trabeculoplasty

We treated 18 patients with open-angle glaucoma with topical 1.0% prednisolone acetate before performing argon laser trabeculoplasty in an attempt to prevent the increase in intraocular pressure frequently observed during the immediate postoperative period. Intraocular pressure was measured hourly for eight hours postoperatively and was increased in 14 patients. The mean maximum increase, 7.72 +/- 8.62 mm Hg, occurred an average of 3.06 +/- 1.86 hours after laser treatment. Substantial increases in intraocular pressure (more than 15 mm Hg) were observed in five patients within eight hours postoperatively. There were no significant differences in the intraocular pressures of these patients and of 20 similar patients with open-angle glaucoma who did not receive corticosteroid therapy immediately, one week, and two months postoperatively. Corticosteroid pretreatment of patients undergoing laser trabeculoplasty apparently does not influence either the increase in intraocular pressure during the immediate postoperative period or the intraocular pressure two months after treatment.

An Instrument for Self-Measurement of Intraocular Pressure

Close monitoring of the intraocular pressure is considered important to the diagnosis and management of glaucoma. We developed an instrument that allows patients to record their own intraocular pressure. A pilot study demonstrates the good acceptance and safety of the self tonometer. Its accuracy meets standardization guidelines for such instruments.

Steroid-induced Ocular Hypertension in Patients with Filtering Blebs

Four patients developed moderate to marked (25 to 42 mm Hg) elevation of intraocular pressure (IOP) while receiving chronic topical corticosteroids following filtration surgery. All of the eyes had good filtering blebs and no obvious reasons for the elevated IOP. The IOP dropped to 20 mm Hg or lower after the steroid drops were stopped. Our cases support the hypothesis that topical corticosteroid medication can cause an elevated IOP in eyes with functioning filtering blebs during the early postoperative period.

A Visual Field Screening Protocol for Glaucoma

In this prospective evaluation of the reliability and efficiency of an optimized visual field screening protocol for glaucoma, we tested 145 eyes (73 patients) with increased intraocular pressures to determine the location of early glaucomatous visual field defects. The field examination, which was used as a control, and protocol testing were performed on a manual Goldmann perimeter using kinetic and suprathreshold static techniques, respectively. Of the 145 eyes tested, kinetic Goldmann perimetry detected 43 eyes with glaucomatous defects. The screening protocol detected 39 defective eyes. There were four false-negative tests and one false-positive test. The false-negative rate of just under 10% was within the range predicted from earlier data. The computer-generated optimal protocols performed as predicted and provided an excellent screening technique for the detection of early glaucomatous visual field defects.

Hla Antigens and Acute Angle-closure Glaucoma

Thirty-five unrelated white patients with acute angle-closure glaucoma and 126 previously healthy unrelated white cadaveric kidney donors were typed for histocompatibility (HLA) antigens. Upon Z-ratio proportionality testing, no association between acute angle closure glaucoma and any specific HLA antigen was noted.