Serum homocysteine, vitamin B 12 and folic acid levels in different types of glaucoma

BACKGROUND: This study was performed to compare levels of serum homocysteine (Hcy), vitamin B12 and folic acid in patients with primary open-angle glaucoma (POAG), pseudoexfoliative glaucoma (PEXG), normotensive glaucoma (NTG) and healthy controls. METHODS: Twentyfive patients with POAG, 24 with PEXG, and 18 with NTG, along with 19 control healthy subjects were included this prospective study. Levels of serum Hcy were measured using immunoassay, and those of serum vitamin B12 and folic acid were measured using competitive chemiluminescent enzyme immunoassay. RESULTS: The mean Hcy concentration in the PEXG group was significantly higher (P < 0.001) as compared to the other groups. There were no significant differences with respect to the mean Hcy concentrations among other groups (P > 0.05). There were no statistical differences in serum vitamin B12 levels among POAG, PEXG, NTG and control subjects (P > 0.05). The mean serum folic acid level was significantly lower in the subjects with PEXG (P < 0.009). However, the mean folic acid concentrations among the other groups did not differ significantly (P > 0.05). CONCLUSION: Elevated levels of Hcy in PEXG may explain the role of endothelial dysfunction among patients with PEXG

Safety and efficacy of fixed-combination travoprost/timolol in patients with open-angle glaucoma or ocular hypertension not controlled with timolol monotherapy

Marcelo Lopes da Silva Jord&atilde;o,1 Marcelo Hatanaka,2 Abayomi Ogundele,3 Maria Rosa Bet de Moraes Silva,4 Roberto Murad Vessani5 1Faculty of Medicine of Ribeir&atilde;o Preto, University of S&atilde;o Paulo, S&atilde;o Paulo, Brazil; 2University of S&atilde;o Paulo School of Medicine, S&atilde;o Paulo, Brazil; 3Global Medical Affairs, Alcon Laboratories, Inc., Fort Worth, TX, USA; 4Faculty of Medicine of Botucatu, Universidade Estadual Paulista (UNESP), S&atilde;o Paulo, Brazil; 5General Hospital of Itapecerica da Serra, Servi&ccedil;o Social da Constru&ccedil;&atilde;o Civil do Estado de S&atilde;o Paulo (SECONCI-SP) S&atilde;o Paulo, Brazil Objective:&nbsp;To assess the intraocular pressure (IOP)-lowering effect of travoprost 0.004%/timolol 0.5% fixed-dose combination (TRAV/TIM&ndash;FC) in patients not achieving the target IOP of &le;18 mmHg while on timolol 0.5% (TIM) monotherapy. Methods:&nbsp;A multicenter, prospective, open-label study (NCT01336569) was conducted in patients with open-angle glaucoma or ocular hypertension. Eligible patients were receiving TIM monotherapy with a screening/baseline IOP of 19&ndash;35 mmHg in &ge;1 eye. TIM was discontinued on the baseline visit day (no washout period) and TRAV/TIM&ndash;FC was initiated and administered once daily at 8 pm for 4&ndash;6 weeks. The primary efficacy variable was mean change in IOP from TIM-treated baseline to study end, measured by Goldmann applanation tonometry. Results were analyzed by analysis of variance and paired samples t-test (5% significance). Results:&nbsp;A total of 49 patients were enrolled (mean age, 63 [range, 42&ndash;82] years; 55.1% White; 73.5% women), and 45 were included in the intent-to-treat (ITT) population. Mean duration of treatment with TRAV/TIM&ndash;FC was 31 days. Mean &plusmn; standard deviation IOP reduction from baseline (TIM) to the follow-up visit (TRAV/TIM&ndash;FC) was -5.0&plusmn;3.6 mmHg. IOP decreased significantly (P&lt;0.0001) from baseline (22.1&plusmn;2.6 mmHg) to study end (17.1&plusmn;3.9 mmHg) in the ITT population, with a mean IOP reduction of 22.3%. Most patients (n=33/45; 73.3%) achieved IOP &le;18 mmHg. Two patients experienced a total of four adverse events (AEs), including a patient who reported one serious AE (enterorrhagia) that was considered unrelated to treatment, and a patient who reported one event each of drug-related redness, pruritus, and foreign body sensation. Most patients (n=47/49; 95.9%) reported no AEs. Conclusions:&nbsp;TRAV/TIM&ndash;FC lowered IOP in patients who were not at target IOP while receiving TIM monotherapy, with most patients achieving an IOP &le;18 mmHg with TRAV/TIM&ndash;FC. TRAV/TIM&ndash;FC was well tolerated in this population.&nbsp; Keywords: DuoTrav&reg;, intraocular pressure, primary open-angle glaucoma, time since diagnosi

Association of exfoliation syndrome and central retinal vein occlusion: an ultrastructural analysis

Purpose: To evaluate prospectively the frequency with which exfoliation syndrome (XFS) occurs in patients with central retinal vein occlusion (CRVO) by clinical examination and ultrastructural examination of conjunctival biopsy specimens. Methods: Prospective observational case series. Thirty-six eyes of 36 consecutive patients with CRVO were investigated for XFS by slit-lamp examination and conjunctival biopsy when XFS was not clinically visible on examination. Results: A clinical diagnosis of XFS or a positive biopsy result for exfoliation material (XFM) was present in 22 of the 36 patients (61%; 95% confidence interval 45-75%). Twelve of these 22 patients (54%) had a clinical diagnosis of XFS. Aggregates of XFM were identified ultrastructurally in the biopsy specimens in 10 of 24 patients with no clinical signs of XFS (42%). Patients with and without XFS had similar distribution of age, gender, race and prevalence of systemic disorders. Twelve of the 22 (54%) XFS patients had neither glaucoma nor ocular hypertension prior to the CRVO. Conclusion: In accordance with previous retrospective and histological studies, this prospective, in vivo study suggests that CRVO is commonly associated with XFS.8819195New York Glaucoma Research Institute, New York CityDeutsche Forschungsgemeinschaft [SFB 539]Deutsche Forschungsgemeinschaft [SFB 539

Evaluation of retinal nerve fiber layer and ganglion cell complex thickness after ocular blunt trauma

Purpose:To evaluate circumpapillary retinal nerve fiber layer (cpRNFL) and ganglion cell complex (GCC) after ocular blunt trauma.MethodsBest-corrected visual acuity (BCVA), cpRNFL and GCC were evaluated by RTVue-100 OCT in all consecutive patients with previous monocular blunt trauma seen between January 2012 and December 2012.ResultsTwenty-two patients (11 females, 11 males, mean age 43.9±14.2 years) were included in the study. Patients were seen after a mean of 8.42±13.3 (range, 0.08-55.3) years from ocular blunt trauma. BCVA was normal in 11 cases and was less than 0.4 LogMAR in all cases. In 9/22 patients (40.9%), cpRNFL and GCC were reduced, whereas in one case an isolated reduction of GCC with normal cpRNFL was present. In patients with reduction of cpRNFL and GCC, mean BCVA was 0.17±0.17 LogMAR. In 6/9 patients (66.6%) with cpRNFL and GCC reduction, BCVA was ≤0.1 LogMAR.ConclusioncpRNFL and GCC reduction may be present after ocular blunt trauma and may be associated with preserved visual acuity

Homocysteine, folates, and the eye.

Plasma homocysteine has been identified as a risk factor for arterial disease, retinal artery and vein occlusions, and other common eye diseases. The value of treating an elevated plasma homocysteine with folic acid for preventing further vascular disease has not been proven. Although secondary prevention of coronary artery disease using this approach has been unsuccessful, trials on primary prevention of stroke and loss of cognitive function with folic acid supplementation appear to be successful. Further trial data are awaited. In patients with premature retinovascular disease, the measurement of plasma homocysteine is suggested and reduction of elevated homocysteine with folic acid for secondary prevention of retinal arterial and venous occlusion. Meanwhile, the debate on fortification of flour for primary prevention of neural tube defects, which has already taken place in North America, continues in European countries. Such fortification could have an impact on primary and secondary prevention of vascular disease