Yara Catoira-Boyle

Efficacy, safety, and survival rates of IOP-lowering effect of phacoemulsification alone or combined with canaloplasty in glaucoma patients.

Purpose:To evaluate efficacy and survival rates of intraocular pressure (IOP)-lowering effect obtained with phacoemulsification (phaco) alone or in combination with canaloplasty (PCP) in patients with open-angle glaucoma (OAG). Methods:Retrospective chart review of consecutive cases at the Department of Ophthalmology, Indiana University. Visual acuity (VA), IOP, number of medications (Meds), failures, and survival rates of IOP-lowering effect were analyzed. Inclusion criteria were: patients older than 18 years with OAG and cataract. Exclusion criteria were: no light perception vision, prior glaucoma surgery, chronic uveitis, angle-closure glaucoma, and advanced-stage or end-stage OAG. Failure criteria were: IOP>21 mm Hg or <20% reduction, IOP<6 mm Hg, further glaucoma surgeries, and loss of light perception vision. Results:Thirty-seven patients underwent phaco and 32 patients had PCP. Follow-up was 21.8±10.1 versus 18.8±9.6 months for phaco and PCP, respectively (P=0.21). Age (y) (74.7±9.8 vs. 76.1±8.3, P=0.54), sex (P=81), and laser status (P=0.75) were similar between the groups. Preoperatively, mean±SD logMAR VA (0.5±0.7 vs. 0.5±0.5, P=0.77), IOP (16.2±4.6 vs. 18.2±5.1, P=0.13), and Meds (1.4±1.1 vs. 1.3±0.7, P=0.75) were similar for phaco and PCP, respectively. At 24-month phaco (n=17) and PCP (n=11), respectively, mean±SD were: logMAR VA 0.2±0.2 versus 0.4±0.7, P=0.29; IOP 14.1±4.0 versus 12.9±3.8, P=0.43; and Meds 1.5±1.2 versus 0.3±0.5, P=0.005. Rates of successful IOP lowering without medications for phaco versus PCP at 12 months were 34% versus 75%, respectively (P=0.003). Conclusions:A combination of canaloplasty with phaco results in a decreased number of glaucoma medications and increased survival rate of IOP-lowering effect compared with phaco alone.

Absorption of Brimonidine 0.1% and 0.15% Ophthalmic Solutions in the Aqueous Humor of Cataract Patients

PurposeTo determine and compare the human aqueous humor (AH) concentrations of 2 formulations of brimonidine ophthalmic solution [0.1% brimonidine Purite (BP) (average pH 7.4 to 8.0) and 0.15% BP (average pH 6.6 to 7.4)]. Patients and MethodsSingle-center, randomized, controlled, double-masked, prospective study. Twenty-two patients were randomized to receive one 30-μL drop of 0.1% (n=11) or 0.15% BP (n=11) into the eye requiring routine cataract surgery. Solutions were administered approximately 40 to 55 minutes before surgery and AH samples (100 μL) were withdrawn from treated eyes at surgery initiation. Times from instillation to sampling were recorded. Brimonidine AH concentrations were assayed by high performance liquid chromatography-tandem mass spectrometry. ResultsMean brimonidine AH concentrations sampled 52±9 and 54±8 minutes (P=0.57) after instillation of 0.1% and 0.15% BP solutions were 59.4±42.7 and 95.5±87.5 ng/mL, respectively (P=0.23). When normalized for concentration differences between the 2 formulations, AH concentrations were similar (P=0.85). Both solutions were well tolerated with no adverse events observed. ConclusionsBrimonidine AH concentrations in human eyes after single doses of 0.1% or 0.15% BP ophthalmic solutions were proportional to the respective concentrations of the brimonidine formulation instilled. The pH difference between these 2 formulations seemed to exert no effect on brimonidine bioavailability or the tolerability of the solution.