Shimon Kurtz

HYPERHOMOCYSTINEMIA IN PSEUDOEXFOLIATION GLAUCOMA

PurposeTo determine the prevalence of hyperhomocystinemia in patients with pseudoexfoliation glaucoma. Patients and MethodsThis prospective study included 30 patients with glaucoma and 30 age-matched controls with no history of ocular disease who were undergoing routine physical checkups. Plasma homocysteine levels of all the study participants were determined using high-performance liquid chromatography, and values exceeding 15 &mgr;mol/L were considered elevated. ResultsThe mean plasma homocysteine level was 16.80 ± 3.20 and 12.39 ± 1.97 &mgr;mol/L in glaucoma patients and controls, respectively (P <0.0001). Fifteen glaucoma patients (50%) had hyperhomocystinemia compared with 3 controls (10%) (P = 0.0015). ConclusionHyperhomocystinemia may be associated with pseudoexfoliation glaucoma, which may partially explain the increased risk of vascular diseases among patients with pseudoexfoliation syndrome.

No association between Helicobacter pylori infection or CagA-bearing strains and glaucoma.

Background and PurposeAccumulating evidence indicates that a variety of infections contribute to the pathogenesis of glaucoma. The role of Helicobacter pylori infection in glaucoma is controversial. DesignProspective, population-based study. ParticipantsPatients with various types of glaucoma and a control group of patients with cataract. MethodsWe evaluated seropositivity to H. pylori and to its cytotoxin-associated gene A (CagA) product in patients with various types of glaucoma and compared the findings to those of a control group of patients with cataract. ResultsH. pylori infection and CagA seropositivity were detected in 31/51 (60.8%) and 26/51 (51%) glaucoma patients compared with 22/36 (61.1%) and 19/36 (52%) control patients, respectively (P=0.88, 0.67, not significant). Similar rates of H. pylori infection and CagA-positive strain were found in all glaucoma subgroups, and none of them was statistically different from those of controls. ConclusionsNeither H. pylori infection nor seropositivity for virulent CagA-bearing H. pylori strains have significant association with the occurrence of glaucoma of any type.

C-reactive Protein Levels in Normal Tension Glaucoma

To determine C-reactive protein (CRP) levels in patients with normal tension glaucoma (NTG). Methods:This study included 20 cases with NTG and 30 controls, with no history of ocular disease. Plasma CRP levels of all the study participants were determined using a highly sensitive CRP kit. Results:Twenty cases (11 males, 9 females, mean age 69 ± 5 years) with NTG and 30 age-matched controls (15 males, 15 females, mean age 68 ± 6) were evaluated. Both groups had similar demographic parameters (age, sex, BMI). Plasma CRP levels were significantly higher in the NTG cases than in controls (median [range], 3.20 [0.17-8.4] mg/dL compared with 0.5 [0.1-3.2], P < 0.001). The mean plasma CRP level was significantly elevated in the NTG cases compared with the controls (3.21 ± 0.6 mg/dL and 0.85 ± 0.17 mg/dL, respectively, P < 0 0.01). Conclusion:Our findings suggest that higher CRP levels may be associated with NTG. It is possible that a vascular inflammatory process is involved in the etiology of this glaucoma.

The efficacy of selective laser trabeculoplasty versus argon laser trabeculoplasty in pseudophakic glaucoma patients

Introduction: This study evaluated and compared the efficacy of selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) in terms of intraocular pressure (IOP)-lowering effects in pseudophakic patients at various time points after treatment. The primary aim was to compare the efficacy of SLT and ALT in reducing the IOP of pseudophakic glaucoma patients who recently underwent successful cataract extraction surgery. The secondary endpoint was to determine the percentage of SLT and ALT patients whose IOP was successfully reduced by at least 15% from baseline. Patients and methods: This study was a follow-up of a prospective randomized clinical trial. Fifty-two eyes from 52 glaucoma patients with uncontrolled IOP who had previously undergone successful phacoemulsification-assisted cataract excision surgery with intracapsular lens implantation were randomly assigned to treatment with either ALT (n = 30) or SLT (n = 22). Fifteen patients were excluded due to adverse events encountered during the study, leaving a total of 18 and 19 patients in the ALT and SLT groups, respectively. IOP measurements were carried out at scheduled intervals until 12 months post-laser treatment. Results: There were no significant differences in the IOP-lowering effects between the two methods at any time point during the follow-up period. The greatest differences between the two groups were observed at 1 week posttreatment and at the 3-month time point, but neither reached a level of significance. At the final checkup, the mean IOP reduction from baseline was 3.23 mmHg in the ALT group and 4.30 mmHg in the SLT group (P = 0.269). At that visit, six (35.3%) patients in the ALT group and 15 (75%) patients in the SLT group had a reduction of ≥15% from their baseline IOP. Conclusion: SLT and ALT are equally effective in their IOP-lowering capabilities in new pseudophakic glaucoma patients during the first 12 months after treatment.

Incidence of hyperemia associated with bimatoprost treatment in naïve subjects and in subjects previously treated with latanoprost.

Purpose Bimatoprost is a potent hypotensive drug used in the treatment of glaucoma or ocular hypertension with lower target intraocular pressure (IOP) than latanoprost. Its most disturbing side effect is conjunctival hyperemia. The authors compared the extent of conjunctival hyperemia in patients receiving bimatoprost as initial therapy with that in patients whose treatment with latanoprost was replaced by bimatoprost. Methods One group of consecutive patients with newly diagnosed bilateral primary open-angle glaucoma (POAG) was treated with once daily bimatoprost 0.03% ophthalmic solution as initial therapy. Treatment in another group of patients who had been on latanoprost treatment for at least 3 months was replaced by bimatoprost 0.03%. Conjunctival hyperemia was assessed by a single masked observer using a five-point grading scale. Results The mean ± SD baseline hyperemia scores were 0.4±0.3 and 0.70±0.3 for the firstline and replacement groups, respectively. Following 3 weeks of treatment, the mean post-treatment conjunctival hyperemia scores were 2.3±1 and 1.1±0.5, respectively. IOP of 25.2±9.8 mmHg and 18.95±2.1 mmHg dropped to 18.79±2.13 mmHg and 18.23±1.95 mmHg, respectively, following bimatoprost therapy. The differences in baseline levels of hyperemia for each group were not statistically significant (p=0.478). Changes in hyperemia scores from baseline were highly significant (p<0.001) only in first-line therapy patients (p=0.02 for the replacement group). Conclusions The above findings suggest that patients already on prostaglandin therapy may be less likely to experience an increase in conjunctival hyperemia induced by bimatoprost.

Standard Trabeculectomy and Ex-PRESS Miniature Glaucoma Shunt: A Comparative Study and Literature Review

Purpose:The aim of this study was to compare the efficacy and safety between standard trabeculectomy and the Ex-PRESS shunt implantation. Methods:A retrospective review of the records of 100 eyes of 100 patients who underwent trabeculectomy or Ex-PRESS shunt implantation between July 2010 and June 2012 was conducted. Of these, 61 (61%) eyes underwent trabeculectomy and 39 (39%) eyes underwent Ex-PRESS shunt implantation. Demographic information, glaucoma type, surgical details, preoperative, and postoperative data including intraocular pressure (IOP), number of medications, reoperation, and occurrence of any complications were recorded. Results:No differences in IOP reduction or number of postoperative IOP-lowering medications were demonstrated between the 2 procedures. Success rates were 86.9% for trabeculectomy and 84.6% for Ex-PRESS shunt. Rates of failure and hypotony were not significantly different between the groups. No parameter was correlated with success or failure of any procedure. Conclusions:Standard trabeculectomy and Ex-PRESS shunt have similar efficacy and safety profiles. As the Ex-PRESS shunt is considerably more expensive, its use may be unjustified, especially as a primary procedure.

Measurements of intraocular pressure by Goldmann tonometry, Tonopen XL, and the transpalpebral tonometer, TGDc-01, after penetrating keratoplasty: a comparativye study.

Purpose: The aim of this study was to compare intraocular pressure (IOP) measurements obtained by Goldmann tonometry (GT), the Tonopen XL, and a new transpalpebral tonometer, TGDc-01, in eyes that had undergone penetrating keratoplasty (PKP). Methods: IOP was measured in post-PKP eyes by means of GT, Tonopen XL, and TGDc-01. Central corneal thickness measurements were also obtained for all eyes. Results: Forty-five eyes of 43 patients were enrolled in the study. The mean IOP difference (±SD) was −0.42 ± 5.83 mm Hg between GT and Tonopen and 3.20 ± 7.55 mm Hg between GT and TGDc-01. The correlation coefficient was 0.84 between GT and Tonopen XL (P < 0.001) and 0.71 between GT and TGDc-01 (P < 0.001). Overall 2-way analysis of variance between the means showed no significant differences between the 3 devices (P = 0.077). Conclusions: A closer agreement was found between GT and Tonopen XL in post-PKP eyes. TGDc-01 yielded lower IOP readings than the other 2 devices. It remains uncertain whether this new transpalpebral tonometer is simply inaccurate or whether avoiding contact with the corneal graft by measuring IOP through the eyelid enables it to provide more accurate IOP readings than those obtained by transcorneal techniques.

The efficacy and safety of once-daily versus once-weekly latanoprost treatment for increased intraocular pressure.

We evaluated the efficacy and safety of latanoprost eye drops once-weekly, compared to once-daily for improving patient compliance. Twenty (20) patients (11 women and 9 men), 12 with ocular hypertension and 8 with early glaucoma, were studied after washout of the antiglaucoma treatment. One (1) group was treated with latanoprost once-daily (control). The other group was treated once-weekly (study group). Intraocular pressure (IOP) was measured at baseline and on the 2nd, 4th, 6th, and 9th day after the last drop in the study group, and for 3 months on the same schedule thereafter. The mean baseline IOP was 24.3 +/- 3.9 mmHg in the study group (range, 18-29) and 24.4 +/- 4.4 mmHg in the control group (range, 17-32). The average IOP at all time points of post-treatment was 17.7 +/- 1.5 mmHg (range, 14-23) and 16.9 +/- 2.30 mmHg (range, 13-21), respectively. Latanoprost significantly lowered IOP in both groups (study group, p = 0.005; controls, p = 0.0019). The difference between post-treatment IOP was insignificant in both groups at each time point. The study group had fewer minor side effects than the control group (1/10 versus 6/10, respectively). Latanoprost treatment once-weekly was as effective, and bore fewer minor side effects, as once-daily treatment after 3 months of follow-up.

Topical Bevacizumab for Neovascular Glaucoma: A Pilot Study

Background/Aims: Bevacizumab (Avastin), an anti-vascular endothelial growth factor drug, has been successfully used in recent years to treat ocular pathologies, mostly by intravitreal administration. The aim of this study was to investigate the safety and efficacy of topically applied bevacizumab for the treatment of neovascular glaucoma (NVG). Methods: Patients with NVG were treated with topical bevacizumab (25 mg/ml) 4 times daily during 2 weeks. The following parameters were evaluated at baseline and on days 3, 7 and 14: visual acuity, slit-lamp examination, intraocular pressure (IOP), heart rate and systemic blood pressure. Iris neovascularization was documented using slit-lamp color photos at baseline and on day 14. Results: Eight eyes of 8 patients with NVG were evaluated. After the 2-week treatment, mean IOP was lowered from 34.9 mm Hg (SD 12.8) at baseline to 28.8 mm Hg (SD 9.9) on day 14, representing a mean reduction of 6.1 mm Hg (17.5%). Three patients had clinical regression of their iris neovascularization. Ocular adverse events were transient and included mild upper eyelid swelling, mild exacerbation of superficial punctate keratitis and mild corneal epithelial bullae in an already edematous cornea. There were no serious systemic adverse events. Conclusions: Topical application of bevacizumab may lower IOP and result in regression of neovascularization in patients with NVG.

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.