Luca Cimino

Effect of bimatoprost on patients with primary open-angle glaucoma or ocular hypertension who are nonresponders to latanoprost

PURPOSEnTo test the efficacy of bimatoprost 0.03% 2D for lowering intraocular pressure (IOP) in patients affected by primary open-angle glaucoma or ocular hypertension who did not respond to treatment with latanoprost 0.005% 2D.nnnDESIGNnProspective, randomized clinical trial with a cross over design (two 30-day treatment phases with a 30-day washout phase in between).nnnPARTICIPANTSnFifteen patients were enrolled. Random allocation to treatment to a single eye only of every subject.nnnELIGIBILITY CRITERIAn(1) IOP > 22 mmHg in both eyes on current treatment (on three separate readings > 24 hours apart), (2) angle wide open in both eyes, (3) no pseudoexfoliation and/or pigment dispersion in either eye, (4) documented medical history consistent with < 10% IOP decrease in both eyes on 2-month treatment with latanoprost 0.005% every day.nnnMETHODnThe following variables were measured at each study visit: (1) IOP (Goldmann applanation tonometry, 5 readings, 8 AM, 12 noon, 4 PM, 8 PM, and 12 midnight); (2) visual acuity (Early Treatment of Diabetic Retinopathy Study chart, logarithm of the minimum angle of resolution); (3) estimate of conjunctival hyperemia based on 5 standard photographs (graded as none, trace, mild, moderate, and severe).nnnMAIN OUTCOME MEASUREnIOP.nnnRESULTSnIOP data (mean and standard deviation) were the following: baseline = 24.7 +/- 0.9 mmHg, after washout = 24.8 +/- 1.1 mmHg, after latanoprost phase = 24.1 +/- 0.9 mmHg, after bimatoprost phase = 18.1 +/- 1.7 mmHg. IOP on bimatoprost proved lower than both baseline (P < 0.0001) and latanoprost (P = 0.0001). Thirteen of 15 patients showed a > or =20% IOP decrease with bimatoprost treatment. None of the 15 patients showed a > or =20% decrease of IOP after 30 days of latanoprost treatment. No significant IOP changes were observed in the fellow untreated eye in each patient throughout the study. Trace-to-mild conjunctival hyperemia was recorded more often with bimatoprost phase (P = 0.035).nnnCONCLUSIONSnThirteen of 15 patients, who were nonresponders to latanoprost, 0.005%, 2D, were successfully treated with bimatoprost, 0.03%, 2D. Bimatoprost treatment was associated with a higher incidence of trace-to-mild conjunctival hyperemia than latanoprost.

Sensitivity of indocyanine green angiography for the follow-up of active inflammatory choriocapillaropathies

BACKGROUND: Inflammatory choriocapillaropathies (choriocapillaritis) correspond to the clinical spectrum of lesions of the fundus, including acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis (MC), and other rarer entities caused by inflammatory disturbances of choriocapillaris perfusion. The aim here was to study the sensitivity of indocyanine green (ICG) angiography in investigating and following inflammatory choriocapillaropathies. PATIENTS AND METHODS: Patients with inflammatory choriocapillaropthies were included who had had a dual fluorescein and ICG angiography as well as visual field testing (Goldman or computerized perimetry) at presentation and on follow-up visits. ICG angiography was performed according to a routine angiographic protocol used for inflammatory diseases and was correlated with fundus examination, fluorescein angiography, and visual field testing. RESULTS: Three patients with MEWDS, two with APMPPE, and two with MC were included. The visual field alterations in all seven patients were well correlated with the extent of the hypofluorescent areas seen on ICG angiography, whereas they were badly correlated with fluorescein angiographic signs and their evolution. The visual field in MEWDS was particularly well correlated with the importance of peripapillary hypofluorescence seen on ICG angiography. In MC, the evolution of new lesions was well demonstrated by ICG angiography and well correlated with visual symptoms and visual fields, but was barely detected on fundus examination and by fluorescein angiography. CONCLUSIONS: ICG angiographic signs were shown to be closely correlated with visual function (visual field testing). This was not the case for either fundus examination or fluorescein angiography. ICG angiography appears as a very sensitive follow-up parameter in inflammatory choriocapillaropathies, giving morphological information on the evolution of the disease and on the response to treatment when therapy is indicated.

Effect of brimonidine on intraocular pressure in normal tension glaucoma: A short term clinical trial

Purpose To evaluate the efficacy and safety of 0.2% brimonidine eye drops given twice daily in normal tension glaucoma. Patients and Methods Sixteen consecutive patients fulfilling eligibility criteria (glaucomatous optic neuropathy associated with visual field defect in at least one eye, intraocular pressure (IOP) = 18 mmHg (average of the two highest readings of the round-the-clock curve, including one reading at midnight in supine position), no prior glaucoma therapy, angle wide open, visual acuity 20/40 or better) were enrolled in this prospective, randomized, placebo-controlled clinical trial with crossover design, lasting 30 days for each treatment phase plus 15-day washout in between. Main outcome was IOP (average of the two highest readings of the round-the-clock curve). Results Mean IOP was significantly reduced by brimonidine (from 17.1 ± 0.7 mm Hg to 13.9 ± 2.2 mmHg, p<0.001 (paired Student t-test)). At the end of the 30-day brimonidine phase, 4 of 16 subjects showed a ≥30% IOP decrease over baseline. Conclusions In the short term, 0.2% brimonidine eye drops can induce a significant IOP decrease in eyes with normal tension glaucoma.

Autoimmune uveitis in children: clinical correlation between antinuclear antibody positivity and ocular recurrences.

Abstract.Objective. The aim of this study was to identify the correlation between antinuclear antibody (ANA) titre and the onset and clinical course of uveitis in children with juvenile idiopathic arthritis (JIA) or without any other systemic autoimmune disease, i.e., idiopathic uveitis (IU). Methods. Twenty-two patients affected by uveitis were examined. Ten had JIA-associated uveitis, 12 had IU. Follow-up ranged from 7 to 101 months. The ANA were titrated three times per year and additionally in case of ocular recurrences. All patients were treated with immunosuppressive drug combination therapy (IDCT). Results. JIA-associated uveitis: ocular recurrences were noted in three ANA-positive patients and in one ANA-negative patient. IU uveitis: ocular recurrences were noted in one ANA-positive and in one ANA-negative patient. No significant rise in ANA titre was noted in either group during uveitis recurrence. Conclusions. (1) ANA had no value in predicting the recurrence of uveitis. (2) IDCT does not influence ANA production.

Non-penetrating vs Penetrating Surgery of Primary Open-Angle Glaucoma

Non-penetrating procedures have recently gained attention within the scientific community. An at times fierce debate concerning their role as a successor to the gold standard, trabeculectomy, has revolved around its relative effectiveness in short-to medium-term intraocular pressure control. Several controlled clinical trials, comparing both surgical procedures in terms of long-term IOP control, safety, and visual outcomes are underway and some short-to medium-term results are already available [4, 14]. However, we must remember that the goal of any glaucoma surgery is: (a) to reach the “guess” timated target IOP in the individual patient, (b) without threatening the patient’s visual function, and (c) at a sustainable cost for the community. We will discuss what penetrating and non-penetrating surgery can offer.