Shani Golan

Original and generic latanoprost for the treatment of glaucoma and ocular hypertension: are they really the same?

We compared the intraocular pressure (IOP)‐lowering effect and safety profile of latanoprost (Xalatan) with its generic variant, Glautan (Unipharm, Tel Aviv, Israel). After 1 and 4 weeks of treatment, a randomized, prospective, cross‐over comparison was carried out that included patients with open‐angle glaucoma or ocular hypertension, either naïve or treated and well‐controlled, who were attending the Department of Ophthalmology, Tel Aviv Medical Centre, Tel Aviv, Israel, between May 2010 and November 2012. After a 3‐week washout period for the medicated subjects, the participants were randomized to 4 weeks of treatment with either Xalatan or Glautan once every evening and then, after a 3‐week washout period, crossed‐over to the other treatment for an additional 4 weeks. Efficacy was expressed by a change in intraocular pressure at three designated hours of the day after 1 week and 1 month of treatment, and tolerability was determined by ocular side‐effects as reported by the patient in a questionnaire. A total of 19 patients (mean age at initial diagnosis 66 ± 9 years, 14 females) were enrolled, of whom 17 had bilateral open‐angle glaucoma and two had unilateral disease. Both drugs lowered intraocular pressure after 1 week and 1 month (P = 0.06 and P = 0.04, respectively) of treatment. Xalatan had a tendency of greater efficacy than Glautan both after 1 week and 1 month, but the difference was not statistically significant (P =0.69 and P = 0.34, respectively). Drug safety was similar for Xalatan or Glautan, but more ocular side‐effects were reported after treatment with Glautan (21 vs 12 for Xalatan, P = 0.06).

Anterior Chamber Bleeding After Laser Peripheral Iridotomy

IMPORTANCE To our knowledge, this is the first study to describe the correlation of anterior chamber bleeding after laser peripheral iridotomy (LPI) and antiplatelet therapy. OBJECTIVE To determine the incidence and amount of anterior chamber bleeding after laser peripheral iridotomy in patients whose condition is suggestive of primary angle-closure glaucoma (PACS) who continued their antiplatelet or anticoagulant treatment before undergoing LPI compared with when they discontinued treatment. DESIGN AND SETTING A prospective controlled trial. PATIENTS Patients with suspected bilateral primary angle-closure and no other ocular disease who take antiplatelet or anticoagulant medications regularly (from January 2010-October 2011) were enrolled. MAIN OUTCOME AND MEASURE The incidence of anterior chamber bleeding with and without antiplatelet and anticoagulant therapy. RESULTS A total of 104 patients (208 eyes) participated in the study. Thirty-six eyes (34.6%) in the treated and untreated arms bled. The amount of bleeding did not differ significantly when the patient was on or off antiplatelet or anticoagulant treatment, nor did the immediate postprocedure mean intraocular pressure (P = .13). The type of antiplatelet or anticoagulant, total laser energy, age, sex, or color of irides were not risk factors for increased bleeding (P = .156 for all parameters). CONCLUSIONS No indication was noted for discontinuing these medications before a high-powered pulsed laser peripheral iridotomy.

Long-term follow-up of intravitreal bevacizumab in retinal arterial macroaneurysm: a case report.

Purpose: To present the long-term effect of intravitreal bevacizumab (Avastin®) therapy in a patient suffering from retinal arterial macroaneurysm. Methods: Case report of a 72-year-old female diagnosed with retinal macroaneurysm in the superior temporal artery leading to macular edema. Functional and morphological data at baseline, 4 weeks, 2 months, and 13 months following treatment with two consecutive intravitreal bevacizumab injections are presented. Results: Best-corrected visual acuity improved from 20/160 at baseline to 20/20 at the3-months follow-up and remained stable through 13 months of follow-up. Central retinal thickness measured by optical coherence tomography decreased from 364 µm at baseline to 248 µm at the 13-months follow-up. No ocular or systemic side effects were detected. Conclusions: Intravitreal bevacizumab therapy may lead to resolution of macular edema associated with retinal macroaneurysm and consequently visual improvement. This treatment may promise a long-lasting effect but warrant further investigation in larger series.

Diode laser cyclophotocoagulation for nanophthalmic chronic angle closure glaucoma.

Purpose:To retrospectively evaluate the results of diode laser cyclophotocoagulation (CPC) in patients with nanophthalmos. Methods:The data on all bilaterally nanophthalmic patients who underwent diode laser CPC in our department between 2004 and 2012 were retrieved and evaluated. Results:Four patients fulfilled study entry criteria. All 4 were females aged 58, 62, 68, and 74 years. The mean preoperative intraocular pressure of 46±5.7 mm Hg dropped to 16.2±1.5 mm Hg at the final follow-up visit (43.5±16 mo). Visual acuity did not change in 2 patients and slightly worsened in the other 2. Choroidal detachment was observed in all patients between 7 and 14 days after the procedure and lasted for 1 to 2 months, resolving spontaneously in 2 patients and following systemic steroid treatment in the other 2. Conclusions:Diode laser CPC was an effective treatment for patients with glaucoma secondary to nanophthalmos.

Surgical treatment for macular edema.

Abstract Objective or Purpose: Macular edema (ME) is secondary to various disease processes. It is most commonly seen following venous occlusive disease, diabetic retinopathy, posterior segment inflammatory disease, and vitreomacular traction syndromes. Treatment varies, depending upon the underlying etiology, and has led to varying degrees of success. Advances in vitreoretinal surgical techniques over the years have expanded the list of indications for vitreoretinal surgical treatment. The purpose of this review is to outline the current use of vitreoretinal surgery and highlight the ever-growing indications for surgery in macular edema. Design: This is a comprehensive review, using Medline, of all literature published on vitreoretinal surgery for macular edema secondary to various conditions. Results: Over 450 abstracts were reviewed, and the articles pertinent to our discussion were selected. The search words were “macular edema” and “pars plana vitrectomy” or “surgery.” Conclusions: The pathology of the vitreous body is associated with ME in several different conditions, and vitreoretinal surgical techniques can be effective in the management of ME in the majority of them. The ever-expanding new surgical techniques, as well as the new pharmacologic agents used during surgery, show great promise for the future.

Poor correlation between intracranial pressure and intraocular pressure by hand-held tonometry.

Purpose The aim of this study is to provide data on the controversial issue of whether handheld measurements of intraocular pressure (IOP) are capable of accurately predicting elevated intracranial pressure (ICP) in patients undergoing lumbar puncture (LP). Methods All patients over the age of 18 years who underwent an LP in the emergency or neurological departments at the Tel Aviv Medical Center for any reason between October 2007 and July 2010 were eligible to participate in this prospective observational pilot study. IOP was measured with the Tono-Pen XL while patients were in the supine position before undergoing LP. ICP was measured in the lateral recumbent position. ICP and bilateral IOP were measured, and the mean and maximum values of IOP were calculated. The association between ICP and each one of the four IOP measures was evaluated by the Pearson correlation coefficient. Results Twenty-four patients (mean age 37.8 ± 15.8 years, ten males and 14 females) were enrolled. The reasons for their requiring an LP were headache (19/24 patients), evaluation for hemiparesis (2/24), cognitive deterioration (1/24), and seizures (2/24). Nine had elevated mean opening pressure (>20 cm H2O), six had an elevated mean IOP (>20 mmHg), and four of these six also had an elevated opening pressure. There was no significant correlation between the ICP measurements and any of the IOP measurements. Conclusion Handheld ocular tonometry has poor sensitivity and specificity for the prediction of increased ICP and is not an effective tool for screening for ICP in the ED or in the neurology department.

Steroids and the Management of Macular Edema

Macular edema (ME) is a condition which is usually secondary to an underlying disease process. It is most commonly seen following venous occlusive disease, diabetic retinopathy and posterior segment inflammatory disease. The treatment of ME varies, depending upon the underlying etiology, and has led to varying degrees of success. Traditionally, the main treatment options have included topical and systemic steroids, due to their known antiangiogenic, antiedematous, antiinflammatory and antiproliferative effects. This comprehensive review outlines the current use of steroids and highlights the ever-growing indications for steroids in ME secondary to various ocular conditions as well as the recent breakthrough results of the efficacy of this treatment.

The prevalence of glaucoma in patients undergoing surgery for eyelid entropion or ectropion

Purpose and design The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed. Participants All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial. Methods The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period. Main outcome measure In this study, the prevalence of glaucoma in individuals with ectropion or entropion was the main outcome measure. Results A total of 227 patients (57% men, mean age: 79.2 years) who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01), 30 of the study patients (13.2%) had coexisting glaucoma. Of 30 glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3 years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications. Conclusion An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in elderly patients.

Euretina in a blink

The 12th Euretina Congress Milan, Italy, 6–9 September 2012 The congress provided a chance for retina specialists all over the world to listen and learn from international world-leading experts in retina sharing their experience and knowledge. Main sessions, free paper presentation sessions, instructional courses and wetlabs took place throughout the 4-day meeting. In addition, joint symposia with both ESCRS and WCPOS added an exciting dimension to the program.