Joseph M. deFaller

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.

Identification and characterization of the ocular hypotensive efficacy of travoprost, a potent and selective FP prostaglandin receptor agonist, and AL-6598, a DP prostaglandin receptor agonist

The structure-activity studies that led to the identification of travoprost, a highly selective and potent FP prostaglandin analog, and AL-6598, a DP prostaglandin analog, are detailed. In both series, the 1-alcohol analogs are very effective and are thought to be acting as prodrugs for the biologically active carboxylic acids. The efficacy of amide prodrugs depends on the degree of substitution and the size of the substituents. Selected compounds are profiled in vitro and in vivo preclinically. Clinical studies show that travoprost 0.004% (isopropyl ester) provided intraocular pressure control superior to timolol 0.5% when used as monotherapy in patients with open-angle glaucoma or ocular hypertension. In clinical studies, AL-6598 0.01% provided a sustained intraocular pressure reduction with q.d. application; b.i.d. provided greater intraocular pressure control. The acute and, apparently, conjunctival hyperemia associated with topical ocular AL-6598 can be attenuated while maintaining intraocular pressure-lowering efficacy by formulating with brimonidine.

Prophylactic use of apraclonidine for intraocular pressure increase after Nd:YAG Capsulotomies.

We evaluated the prophylactic effect of 1% apraclonidine HCl in controlling the increase in intraocular pressure after Nd:YAG posterior capsulotomy in a large, multicenter double-masked clinical trial. One hundred sixty-four patients were enrolled into the apraclonidine-treated group, and 165 into the vehicle-treated group. The incidence of increase in intraocular pressure (greater than 5 mm Hg) in the apraclonidine-treated group (7%, 11 of 163 patients) was significantly less than that in the vehicle-treated group (39%, 64 of 164 patients). Similarly, the mean maximal change in intraocular pressure in the apraclonidine-treated group (1.3-mm Hg decrease) was significantly different from the increase in the vehicle-treated group (5.3-mm Hg increase). Few adverse reactions were observed. The risk for significant loss of visual function after Nd:YAG laser posterior capsulotomy, combined with the efficacy and relative safety of prophylactic apraclonidine, suggest its addition to the treatment armamentarium.

Anterior Juxtascleral Delivery of Anecortave Acetate in Eyes with Primary Open-Angle Glaucoma: A Pilot Investigation

PURPOSE To describe the intraocular pressure (IOP)-lowering effects in eyes with open-angle glaucoma (OAG) after treatment with an anterior juxtascleral depot of anecortave acetate. DESIGN Prospective, interventional case series. METHODS Seven eyes of six subjects with OAG, with uncontrolled IOP while being administered one or more topical medications, received 24 mg anecortave acetate delivered by anterior juxtascleral depot. IOP was assessed at baseline and regularly after treatment for up to 24 months. RESULTS Mean IOP before anecortave acetate treatment was 31.3 +/- 11.3 mm Hg and dropped by 9.5 +/- 4.5 mm Hg (32.7% +/- 16.8%) within one week after treatment. This IOP reduction was sustained through six months (8.4 +/- 5.4 mm Hg [29.6% +/- 12.4%]) and 12 months (9.5 +/- 5.7 mm Hg [34.0% +/- 15.9%]) after a single anecortave acetate treatment. The injection process was well tolerated, and no eyes experienced any injection-related or drug-related serious adverse events. CONCLUSIONS Both the anterior juxtascleral depot of a drug and anecortave acetate may be promising candidates for IOP reduction in eyes with OAG. Additional studies are required to establish better their efficacy and safety, optimal dosing frequency, mechanism of action, and potential additivity to other IOP-lowering therapies.

Clinical comparison of Provisc and Healon in cataract surgery

Abstract This prospective, randomized, multicenter clinical trial compared the safety and efficacy of the Proviscs® and Healon® viscoelastics. Sixty‐one eyes of 61 patients had an extracapsular cataract extraction with implantation of a posterior chamber intraocular lens with the aid of Provisc (n = 32) or Healon (n = 29). Mean changes in preoperative versus postoperative corneal thickness and intraocular pressure and the incidence and magnitude of postoperative corneal edema and iritis were not significantly different between the two groups. Observed complications were considered consequences of the surgery and unrelated to viscoelastic use. No adverse medical events occurred. These results indicate Provisc and Healon are clinically equivalent in terms of safety and efficacy when used as surgical aids.

Reduction of Intraocular Pressure With Anecortave Acetate in Eyes With Ocular Steroid Injection–Related Glaucoma

OBJECTIVE To evaluate the intraocular pressure (IOP)-lowering potential of anecortave acetate (AA) in eyes with steroid-related ocular hypertension inadequately controlled with the maximal tolerated or appropriate medical therapy. DESIGN Uncontrolled case series. METHODS A total of 8 eyes of 7 subjects with medically uncontrolled IOP following intravitreal or sub-Tenon injections of triamcinolone acetonide were included. All received an 0.8-mL anterior juxtascleral depot of 3% AA solution (24 mg) under topical anesthesia. The IOP was assessed weekly for the first month, then monthly for a minimum of 1 year. RESULTS The mean baseline IOP was 39.9 mm Hg. After 1 week, the mean IOP decreased 12 mm Hg (29%; P = .005) and by 1 month, the mean IOP had decreased 14.1 mm Hg (34.5%; P = .003) from baseline. Four eyes required surgical intervention despite a decrease in IOP because of markedly elevated initial IOP and the degree of preexisting glaucomatous optic neuropathy. We observed no adverse events. CONCLUSIONS An anterior juxtascleral depot of AA lowers IOP substantially in some eyes with medically uncontrolled steroid-related ocular hypertension. Further study is warranted to clarify the role of AA in treating this condition as well as other forms of glaucoma.

Effect of BSS Plus on the Corneal Endothelium with Intraocular Lens Implantation

AbstractBSS Plus, a new intraocular irrigating solution, was compared to BSS (Balanced Salt Solution) in 100 cases of planned extracapsular cataract extraction with the insertion of a Simcoe posterior chamber intraocular lens. Surgery was standardized in all cases, and Healon was not used. Fifty patients received BSS Plus at surgery and 50 patients received BSS. Approximately 10–20 min of introcular irrigation was required for each case. Preoperative and postoperative corneal endothelial cell counts showed a decrease in cell density of 15.4% using BSS Plus, and a decrease of 22.7% using BSS. These differences were statistically significant (p < 0.05).