The impact of glaucoma medication on parameters of ocular perfusion

Whereas intraocular pressure is considered a major risk factor in glaucoma, growing evidence now indicates that ocular ischemia plays a major role too. By virtue of this and because many existing medications are able to interact with vasculature, altering ocular blood flow, it is essential that current and future medications for glaucoma be evaluated for their effect on ocular circulation. The authors review published papers examining the effect of topical and some systemic medications on ocular blood flow, focusing mostly on data from the human eye. The authors provide a comprehensive review on the effect of subclasses of medications (eg, carbonic anhydrase inhibitors, beta-blockers, alpha-adrenergic agonists, and prostaglandin analogues on optic nerve head, and on retinal, choroidal, and retrobulbar circulation. The various claims for enhancements or reduction of ocular circulation within each class of medication are reviewed and evaluated

Postoperative Komplikationen und Management der Filtrationschirurgie

Of the filtering procedures employed, trabeculectomy is the one most frequently used for surgical therapy in primary open angle glaucoma patients. Intra- and postoperative complications must be detected promptly and treated adequately. Many complications arise within the first weeks, such as bleb scaring, decreased flow beneath the scleral flap, extensive filtration with choroidal detachment and anterior chamber narrowing. Fibrin reaction, corneal dellen, iris prolapse, conjunctival leakage and ciliary body detachment are seen more rarely. With prophylactic pre- and perioperative application of antibiotics, wound infections are rare and the risk of endophthalmitis following trabeculectomy remains small. Careful surgical planning requires special consideration of the conjunctiva and provides the basis for long-term success as long as intensive follow-up treatment is ensured. The success of trabeculectomy depends on the preoperative, intraoperative as well as postoperative condition and in particular on bleb development. Early detection of postoperative complications, especially in terms of early scaring in the bleb area, enables implementation of adequate therapeutic measures, such as needling procedures and early bleb revision. Close patient monitoring substantially increases long-term success rates

Glaukome bei primären Irisveränderungen. Axenfeld-Rieger-Syndrome, ICE-Syndrome (essenzielle Irisatrophie, Chandler-Syndrom, Cogan-Reese-Syndrom), Aniridie

Iris malformations are often associated with malformations of the entire eye and systemic diseases. Malformations of the anterior chamber angle can lead to juvenile glaucoma. Axenfeld-Rieger syndromes have autosomal dominant transmission and are associated with juvenile glaucoma in 50-60% of patients. Besides eye anomalies craniofacial malformations are also typical. The etiology of iridocorneal endothelial (ICE) syndrome is unclear but atypical endothelial cells lead to malformations of the entire anterior eye segment of the eye and glaucoma. Aniridia is a bilateral, congenital malformation which manifests sporadically and transmission is usually autosomal dominant. Glaucoma, malformations of the entire eye and systemic malformations are associated with aniridia. Conservative and microsurgical treatment of glaucoma of these syndromes need the cooperation of different medical subspecialties and are often ineffective

Tolbutamide eye drops increase aqueous humor outflow and lower intraocular pressure: a proof of concept for glaucoma treatment

Background: Glaucoma refers to a heterogeneous group of diseases characterized by retinal cell degeneration and optic nerve atrophy leading to blindness. Even though about 40% of patients have normal intraocular pressure (IOP), current treatment. focuses on lowering IOP. With time, current drugs become less effective, which has motivated the search for novel drugs.The objective was to establish whether modulators of ATP-sensitive potassium channels influence IOP. Methods: The double-blind, 5-day short duration Proof-Of-Concept study was carried out at the Ophthalmology Clinic, University of Cologne, Germany. The only inclusion criteria were a diagnosis of glaucoma, ability to understand that they would be treated with an experimental drug, and readiness to sign a consent form. Results: In rabbits, 1 h after topical application of 80 µL of 0.5% tolazamide, tolbutamide, glibenclamide, and chlorpropamide suspended in phosphate buffered saline IOP de-creased, whereas 0.5% diazoxide increased IOP. In Cynomolgus monkeys tolbutamide decreased IOP. In 9 glaucoma patients treated for 5 days with one drop of a 0.5% tolbutamide solution twice daily, IOP was an average of 17% lowered. In one patient with ocular hypertension, tolbutamide lowered IOP by a 5-day average of 29% and increased aqueous humor outflow by 185%. No local adverse effects were observed. Conclusions: The data presented show that blockers of the ATP-sensitive potassium channels lower IOP whereas diazoxide, an ATP-sensitive potassium channel opener, increases IOP suggesting that elevated IOP results from an ionic imbalance. The data suggest that sulfonylurea drugs are useful for the treatment of glaucoma

Unusual bilateral traumatic maculopathy following whiplash injury

An unusual extensive bilateral macular oedema (MO) with spontaneous resolution occurred following a car crash accident. Qualitative and quantitative analysis of the macular region using spectral domain optical coherence tomography (SD-OCT) and multifocal electroretinogram (mfERG) was performed daily during the first 7 days, as well as at 3 and 6 months following the accident. SD-OCT examination demonstrated extensive MO accompanied by neurosensory detachment and subretinal fluid. During the 7 days following the accident there was gradual resolution of the oedema accompanied by visual recovery. One year later no anatomical changes were observed, the mfERG showed complete recovery and visual acuity returned to normal level. Although whiplash is a common injury in motor vehicle accidents, whiplash maculopathy (WMP) is rarely reported, most likely due to underdiagnosis. Here we describe the spontaneous resolution of a severe MO after whiplash injury in a car crash accident

Variability of the normalised rim/disc area quotient estimated by laser scanning tomography. A comparison with conventional planimetry

The introduction of the laser scanning tomograph raises the possibility of the estimation of optic disc morphology in a less subjective and less time-consuming way than the conventional planimetry of fundus photography. The aim of the present study was to estimate the efficiency of the HRT method in a comparison of data collected in a glaucomatous patient group to planimetric data obtained in young normal volunteers

Primary viscocanalostomy versus trabeculectomy in white patients with open-angle glaucoma: a randomized clinical trial

To compare viscocanalostomy, a nonpenetrating procedure for glaucoma treatment, with trabeculectomy