Ricardo Suzuki

A comparison of bimatoprost 0.03% versus the fixed-combination of latanoprost 0.005% and timolol 0.5% in adult patients with elevated intraocular pressure: an eight-week, randomized, open-label trial.

INTRODUCTION AND PURPOSE Bimatoprost and the fixed combination of latanoprost with timolol maleate are 2 medications widely used to treat glaucoma and ocular hypertension (OHT). The aim of the study is to compare the efficacy of these 2 drugs in reducing intraocular pressure (IOP) after 8 weeks of treatment in patients with primary open angle glaucoma (POAG) or OHT. METHODS In this randomized, open-label trial, 44 patients with POAG or OHT were allocated to receive either bimatoprost (1 drop QD) or latanoprost/timolol (1 drop QD). Primary outcome was the mean diurnal IOP measurement at the 8th week, calculated as the mean IOP measurements taken at 8:00 am, 10:00 am, and 12:00 pm Secondary outcomes included the baseline change in IOP measured 3 times a day, after the water-drinking test (performed after the last IOP measurement), and the assessment of side effects of each therapy. RESULTS The mean IOP levels of latanoprost/timolol (13.83, SD = 2.54) was significantly lower than of bimatoprost (16.16, SD = 3.28; P < 0.0001) at week 8. Also, the change in mean IOP values was significantly higher in the latanoprost/timolol group at 10:00 am (P = 0.013) and 12:00 pm (P = 0.01), but not at 8:00 am (P = ns). During the water-drinking test, there was no significant difference in IOP increase (absolute and percentage) between groups; however, there was a significant decrease in mean heart rate in the latanoprost/timolol group. Finally, no significant changes in blood pressure and lung spirometry were observed in either groups. CONCLUSIONS The fixed combination of latanoprost/timolol was significantly superior to bimatoprost alone in reducing IOP in patients with POAG or OHT. Further studies with large sample sizes should be taken to support the superior efficacy of latanoprost/timolol, as well as to better assess its profile of side effects.

Bilateral nonarteritic anterior ischemic neuropathy following acute angle-closure glaucoma in a patient with iridoschisis: case report

A 55-year-old woman was referred to our clinic because of a one-week history of visual loss and raised intraocular pressure in the left eye followed 4 days later by visual loss in the right eye. Slit-lamp examination showed bilateral conjunctival hyperemia, slight diffuse corneal edema, shallow anterior chamber and fixed and dilated pupil in both eyes. Splitting of the anterior layers of the iris with fibrillar degeneration extending for approximately one quadrant inferiorly was presented in each eye. Fundus examination showed optic disc edema with no vascular tortuosity and no cup in both eyes. The condition was treated as bilateral acute angle-closure glaucoma in a patient with irisdoschisis. After medical treatment and improvement of visual acuity, perimetry revealed a significant visual field defect especially in left eye; this case represents a rare concurrence of acute angle-closure glaucoma and bilateral nonarteritic ischemic optic neuropathy. Although most cases of elevated intraocular pressure, including acute angle-closure glaucoma, do not result in optic disc edema and irreversible vision loss, variations in the vascular supply of the nerve optic head along with others ocular systemic risk factors, may predispose certain individuals to nonarteritic ischemic optic neuropathy during periods of elevated intraocular pressure.

Early transconjunctival needling revision with 5-fluorouracil versus medical treatment in encapsulated blebs: a 12-month prospective study

OBJECTIVE: To compare the efficacy of transconjunctival needling revision with 5-fluorouracil versus medical treatment in glaucomatous eyes with uncontrolled intraocular pressure due to encapsulated bleb after trabeculectomy. METHODS: Prospective, randomized, interventional study. A total of 40 eyes in 39 patients with elevated intraocular pressure and encapsulated blebs diagnosed at a maximum five months after primary trabeculectomy with mitomycin C were included. The eyes were randomized to either transconjunctival needling revision with 5- fluorouracil or medical treatment (hypotensive eyedrops). A maximum of two transconjunctival needling revisions per patient was allowed in the needling arm. All patients underwent follow-up for 12 months. Successful treatment was defined as an intraocular pressure ≤ 18 mmHg and a 20% reduction from baseline at the final follow-up. Clinicaltrial.gov: NCT01887223. RESULTS: Mean intraocular pressure at the final 12-month follow-up was lower in the transconjunctival needling revision group compared to the medical treatment group. Similar numbers of eyes reached the criteria for treatment success in both the transconjunctival needling revision group and the medical treatment group. CONCLUSIONS: Despite similar success rates in eyes randomized to transconjunctival needling revision with 5-fluorouracil compared to eyes receiving medical treatment, there was a significantly lower mean intraocular pressure at 12 months after transconjunctival needling revision.

Hipertensão venosa episcleral idiopática unilateral em mulher jovem

O objetivo e relatar o caso de uma paciente de 33 anos, que veio ao Pronto Socorro de Oftalmologia apresentando queixa de reducao da acuidade visual a esquerda, de carater insidioso e progressivo, ha dois anos. Ao exame oftalmologico, apresentava ingurgitamento dos vasos da conjuntiva bulbar, pressao intraocular muito elevada e nervo optico com escavacao total a esquerda. Foi submetida a campimetria computadorizada 24:2 WW e SITA-SWAP do olho direito, ambas com resultados dentro da normalidade. As tomografias de crânio e orbitas, bem como ultrassonografia com doppler do globo ocular, arterias oftalmicas e veias supraorbitarias nao apresentavam anormalidades. Diante disso, aventou-se a hipotese diagnostica de hipertensao venosa episcleral idiopatica, um diagnostico de exclusao, visto que patologias intracranianas e intraorbitarias haviam sido excluidas. Paciente foi tratada clinicamente com colirios hipotensores, com reducao importante da pressao intraocular a esquerda, porem nao o suficiente, evoluindo para trabeculectomia.

Reproducibility of water drinking test

Caro Editor,Gostariamos de congratular os autores pelo interesse emestudar o teste de sobrecarga hidrica (TSH) no glaucoma.(Medina FM, Rodrigues FK, Filho Pde T, Matsuo T, Vascon-cellos JP, Costa VP. Reproducibility of water drinking testperformed at different times of the day. Arq Bras Oftalmol.2009;72(3):283-90)Nos ultimos anos nosso grupo avaliou o TSH em diversassituacoes relacionadas ao controle pressorico em pacientescom diagnostico ja estabelecido e submetidos ou nao a terapiaclinica e (ou) cirurgica, com diferentes niveis de dano glauco-matosoe com evolucoes diferentes em relacao a progressao dadoenca