Keitetsu Abe

Cystoid macular edema associated with topical latanoprost in glaucomatous eyes with a normally functioning blood-ocular barrier.

PurposeTo study prospectively using optical coherence tomography (OCT) whether topical latanoprost induces retinal disorders, such as cystoid macular edema, in patients with glaucoma and a normally functioning blood–ocular barrier. MethodsSixty-eight eyes of 38 patients with glaucoma and no history of intraocular surgery, uveitis, or laser trabeculoplasty were studied. Before initiation of latanoprost treatment and after 1, 3, and 6 months of treatment, OCT images were taken, and the following tests were performed: visual acuity examination, fundus ophthalmoscopy, intraocular pressure measurement, and fundus color photography. To evaluate retinal thickness in the fovea accurately, OCT scanning was repeated six times, and the smallest value was used as the retinal thickness in the fovea. ResultsLatanoprost ophthalmic solution did not influence retinal thickness in the fovea at any investigated time points compared with the time before instillation, and no changes were observed in visual acuity, ophthalmoscopic findings, and fundus photographs. The intraocular pressure was reduced significantly at all investigated time points compared with the time before instillation. ConclusionsIt is unlikely that topical latanoprost induces retinal disorders, such as cystoid macular edema, in glaucomatous eyes with a normally functioning blood–ocular barrier.

A Prospective Study of Iridial Pigmentation and Eyelash Changes Due to Ophthalmic Treatment with Latanoprost

PurposeTo conduct a 12-month prospective study on the occurrence of latanoprost-induced iridial pigmentation and eyelash change in Japanese patients with glaucoma.MethodsSeventy-five patients (75 eyes) were enrolled in the study. Photographs of the iris and eyelashes were taken under identical conditions before and after treatment. Three glaucoma specialists assessed the iridial pigmentation/eyelash change independently with no knowledge of patient data. The effects of age, sex, concomitant medication, and type of glaucoma on iridial pigmentation/eyelash change were investigated, and intraocular pressure (IOP) reduction and iridocorneal angle pigmentation before and after latanoprost treatment were compared between patients with iridial pigmentation/eyelash change and patients without these changes.ResultsThe incidence of iridial pigmentation was 6.3% at 1 month, 15.7% at 3 months, 37.8% at 6 months, and 56.5% at 12 months. The incidence of eyelash change was 0% at 1 month, 33.8% at 3 months, 44.4% at 6 months, and 46.2% at 12 months. Latanoprost did not affect IOP reduction or iridocorneal angle pigmentation. No significant relationship between iridial pigmentation and eyelash change was observed. None of the investigated parameters except age affected the iridial pigmentation/eyelash change.ConclusionIridial pigmentation and eyelash change occurred at a high frequency in long-term treatment with latanoprost in Japanese glaucoma patients. Jpn J Ophthalmol 2004;48:141–147

Quantitative evaluation of changes in anterior segment biometry by peripheral laser iridotomy using newly developed scanning peripheral anterior chamber depth analyser.

Aim: Using the newly developed scanning peripheral anterior chamber depth analyser (SPAC), the effects of peripheral laser iridotomy (PLI) on peripheral anterior chamber depth (PACD) were determined quantitatively as was the association between PACD and chronic elevation of intraocular pressure (IOP) after PLI. Methods: 16 eyes of 15 patients with acute primary angle closure glaucoma (PACG) attack, 14 eyes of 14 patients with narrow angle and PACG attack in their fellow eyes, and 13 eyes of seven patients with chronic angle closure glaucoma (CACG) were enrolled. The SPAC scanned the anterior ocular segment from the optical axis to the limbus and took 21 consecutive slit lamp images at 0.4 mm intervals. A computer installed program automatically evaluated the PACD and the averaged values of three measurements were employed for analysis. Results: PLI significantly increased PACD and changed the iris contour from convex to flat or concave in all the enrolled eyes. The extent of the PLI induced PACD increase was enhanced with increasing distance from the optical axis. Comparing PACDs after PLI, eyes that received prophylactic PLI showed the greatest extent of PLI induced PACD increase, followed by eyes with CACG and eyes with PACG attack. The PACD of eyes with PACG attack was almost the same as that of the fellow eyes of PACG attack before prophylactic PLI. Eyes with PACG attack showed poorer IOP control after PLI than eyes with narrow angle and CACG with PLI. Conclusions: PLI significantly increases PACD and the small PLI induced opening of PACD may contribute to chronic IOP elevation after PLI.

Comparison of iridial pigmentation between latanoprost and isopropyl unoprostone: a long term prospective comparative study

Aim: To compare incidence of iridial pigmentation prospectively induced by long term treatment with latanoprost and isopropyl unoprostone (hereafter, unoprostone) in Japanese patients with glaucoma. Methods: Patients with glaucoma treated with prostaglandin (PG) related ophthalmic solutions were sequentially enrolled. Patients treated for more than 30 months with PG related ophthalmic solutions were subjected to analysis. The entry criteria were no history of intraocular surgery, laser iridotomy, and/or laser trabeculoplasty within 12 months before and after the enrolment; and no history of uveitis; no changes in antiglaucoma drugs within 6 months before and after the enrolment. Photographs of the irides were taken under the same conditions and three glaucoma specialists evaluated the iridial pigmentation with masking of patient information. The correlation of iridial pigmentation with the background factors and the reduction of intraocular pressure (IOP) before and after the treatment were investigated. Results: 48 eyes in 48 patients satisfied the enrolment criteria (25 eyes in the latanoprost group, 23 eyes in the unoprostone group). At the end of the follow up period, iridial pigmentation was present in 15 patients (60.0%) in the latanoprost group and seven patients (30.4%) in the unoprostone group. The correlation between development of iridial pigmentation and age, sex, concurrent use of other ophthalmic solutions, and IOP reduction was not significant. Conclusions: The incidence of iridial pigmentation induced by latanoprost or unoprostone is high in the case of long term treatment. Iridial pigmentation did not affect PG related ophthalmic solution induced IOP reduction.

Iridial pigmentation induced by latanoprost ophthalmic solution in Japanese glaucoma patients.

PurposeTo investigate the incidence of iridial pigmentation induced by latanoprost ophthalmic solution in Japanese glaucoma patients by a prospective and observer-masked study. Patients and MethodsSixty-nine eyes of 69 glaucoma patients were included. Patients who had undergone intraocular surgery, laser trabeculoplasty, and laser iridotomy within 12 months before enrollment, and patients with history of uveitis and any changes in antiglaucoma drugs within 6 months before enrollment were excluded. Iridial photographs were taken by one examiner under the same conditions at 1, 3, and 6 months after the initiation of latanoprost treatment. Three glaucoma specialists, masked of patient information, independently assessed the iridial pigmentation. Cases with iridial pigmentation diagnosed by three specialists were categorized as showing a definite increase in iridial pigmentation. ResultsA definite increase in iridial pigmentation occurred in 3.5%, 9.7%, and 35.0% of eyes within 1, 3, and 6 months of treatment, respectively. Age, gender, or concomitantly used eyedrops did not significantly influence the incidence of iridial pigmentation within 6 months of instillation. A reduction of intraocular pressure by latanoprost did not differ significantly between patients with and without iridial pigmentation. ConclusionThe incidence of iridial pigmentation by latanoprost ophthalmic solution in Japanese patients was higher than previously reported values in pigmented races.

A Case of Cystoid Macular Edema Associated with Latanoprost Ophthalmic Solution

BACKGROUND Although there have been reports of adverse effects after use, it is unclear whether latanoprost ophthalmic solution contributes to the development of cystoid macular edema (CME). CASE A 71-year-old man underwent lens extraction, the insertion of an intraocular lens, and vitrectomy for elevated intraocular pressure (IOP) associated with lens subluxation in the left eye. After the surgery, antiglaucoma ophthalmic solutions controlled IOP well for over a year, maintaining good visual acuity with no abnormalities in the fundus. OBSERVATIONS Two months after the previously prescribed antiglaucoma ophthalmic solutions were replaced by latanoprost, the patients visual acuity decreased and CME developed. When latanoprost was replaced by other antiglaucoma ophthalmic solutions for controlling IOP, CME disappeared and visual acuity returned to the base level. CONCLUSIONS Latanoprost may be involved in the development of CME. Patients who have undergone vitreous surgery or those with aphakia should be carefully observed for the possible development of CME associated with the use of latanoprost, even a long time after surgery.

Visual Acuity and 10° Automated Static Perimetry in Eyes with Retinitis Pigmentosa

Abstract Purpose: In a previous study we demonstrated that the progression of the disease retinitis pigmentosa (RP) can be readily monitored by the mean deviation (MD) measured by Humphrey central 10-2 perimetry, which assesses the sensitivity distribution in the macular area in eyes affected by RP. In the present study, we investigated whether the 10° perimetric results could predict the time of declining visual acuity in eyes with RP in a cross-sectional study. Methods: Humphrey 10-2 perimetry results and visual acuity were studied in the right eyes of 69 patients with typical RP. Patients whose eyes had cataract, glaucoma, cystoid macular edema, or other complications affecting vision were excluded. Results: Eyes with an MD of −15 dB or greater had almost normal visual acuity. Various degrees of visual acuity loss were observed in eyes with an MD of less than −15 dB. In the 35 eyes with an MD of less than −15 dB, visual acuity correlated well with the corrected pattern standard deviation (CPSD), which is the measure of the degree to which the shape of the measured field departs from the age-corrected normal reference field. Conclusion : In the absence of complications, many eyes with RP may experience acuity loss after the field constriction reaches an MD of less than −15 dB. The CPSD may be used as an indicator of acuity because eyes showing a lower CPSD tend to have greater loss of acuity among eyes with an equivalent MD value.

Additive Effect of Brinzolamide on Diurnal Changes in Intraocular Pressure in Latanoprost-treated Eyes

To investigate the effect of brinzolamide on diurnal fluctuations in the intraocular pressure (IOP) in patients on latanoprost ophthalmic solution prospectively was aimed. Eleven patients with primary open angle glaucoma were enrolled in this study. The subjects were admitted to the hospital and had their IOPs measured over 24 hours (10 AM, noon, 2 PM, 4 PM, 6 PM, 8 PM, 10 PM, midnight, 3 AM, 6 AM, and 8AM). After topical administration of brinzolamide twice daily for 4-8 weeks for one eye, they were readmitted and again had their IOPs measured in the same manner as during the previous admission. The additional administration of brinzolamide significantly reduced IOP by 9.7±4.5% during 24-hour, 9.5±4.7% during daytime, and 10.3±5.6% during nighttime, respectively. Brinzolamide exerts additive effects over 24 hours in reducing IOP in patients with glaucoma who are receiving latanoprost ophthalmic solution.

Comparison of a remote operating slit-lamp microscope system with a conventional slit-lamp microscope system for examination of trabeculectomy eyes.

Purpose:To compare 2-dimensional (2D) photo imaging with slit-lamp photo imaging for examination of trabeculectomy eyes, and to compare the accuracy and consistency of examination of trabeculectomy eyes with a remote operating slit-lamp microscope system (referred to as “remote slit lamp” hereafter) and a conventional slit-lamp microscope system (referred to as “slit lamp” hereafter). Methods:Thirty-five eyes of 35 patients having a history of trabeculectomy were enrolled in the study that compared 2D photo imaging with slit-lamp photo imaging for the evaluation of trabeculectomy eyes. Five ophthalmologists evaluated the 2D images and the slit-lamp images independently with masking of patient information. Evaluation scores were compared with those provided by a glaucoma specialist using the slit lamp as standard. Fifteen eyes from 15 patients having a history of trabeculectomy were enrolled in the study that investigated the accuracy and consistency of examination of trabeculectomy eyes with a remote slit lamp and a slit lamp. Results:Central anterior chamber depth, bleb height, and bleb extent evaluated by the slit-lamp photo imaging showed significantly higher consistency with the standard than those evaluated by 2D photo imaging (P<0.05). The remote slit lamp showed good consistency of all the evaluated parameters with the slit lamp and the &kgr; scores of all the evaluated parameters were higher than 0.8. The completion time for evaluation with the remote slit lamp and the slit lamp were 247.3±153.5 and 123.5±53.7 seconds, respectively (P<0.001). Conclusions:Slit-lamp photo imaging is a superior method for examination of trabeculectomy eyes compared with 2D photo imaging. The remote slit-lamp system shows similar potential to the slit-lamp system for the evaluation of trabeculectomy eyes, although the evaluation time is much longer.

Acid Phosphatase Localization in Accumulated Membranous Organelles of Optic Nerve Axons Following Acute Elevation of Intraocular Pressure

Acid phosphatase localization in accumulated membranous organelles of optic nerve axons of guinea pigs following acute elevation of intraocular pressure (IOP) was determined, employing light and electron microscopic enzymic cytochemistry with beta-glycerophosphate as a substrate. Positive reaction products appeared to accumulate in the region of the lamina cribrosa, as revealed with light microscopic enzyme cytochemistry. Electron microscopic enzyme cytochemistry also demonstrated that such reaction products mainly localized on multivesicular or multilamellar bodies and myelin-like structures in the unmyelinated optic nerve axons. Following an acutely elevated IOP, retrograde-moving membranous organelles in the optic nerve axons were found to contain AcPase, suggesting that these organelles could be degraded in the axons through the lysosomal pathway.