OF EIGHT INTRAOCULAR PRESSURE LOWERING DRUGS EVALUATED for the treatment of glaucoma, bimatoprost, latanoprost, travoprost, and timolol are the most effective IOP-reducing drugs in primary open-angle glaucoma and ocular hypertension patients, according to a meta-analysis of randomized clinical trials.

After retrieving 820 articles through a computerized search in Medline, Embase, and the Cochrane Controlled Trials Register, 793 were excluded due to various ineligibility factors. In the remaining articles eligible, 85 percent of patients had to have a diagnosis of primary open-angle glaucoma or ocular hypertension. The remaining 27 articles reporting on 28 randomized clinical trials noted 6,953 participants for the trough, and 6,841 for the peak.

 IOP-Lowering Glaucoma Drugs
Group Generic
from Baseline
from Baseline
of Studies
Placebo Trough
beta-blockers Betaxolol, trough
Betaxolol, peak
Timolol, trough
Timolol, peak
analogs or
Bimatoprost, trough
Bimatoprost, peak
Latanoprost, trough
Latanoprost, peak
Travoprost, trough
Travoprost, peak
Brimonidine, trough
Brimonidine, peak
Brinzolamide trough
Brinzolamide, peak
Dorzolamide, trough
Dorzolamide, peak

The results of the study confirmed that the eight drugs evaluated in the meta-analysis do lower IOP more effectively than a placebo, with bimatoprost achieving the highest IOP reduction (33 percent).
(Ophthalmology 2005;1177-1185)
Valk R, Webers C, Schouten J, Zeegers M, Hendrikse F, Prins M.

CRP  Related  to Progressive AMD
Higher levels of the systemic inflammatory markers C-reactive protein and interleukin 6 are independently associated with the progression of age-related macular degeneration, according to a Boston study.

The study, conducted at the Massachusetts Eye and Ear Infirmary, Boston, involved 251 participants (96 men, 155 women) who were 60 years of age or older, had some indication of nonexudative AMD, and had a visual acuity of 20/200 or better in at least one eye at baseline. The status of AMD was assessed through standardized grading of fundus photographs, and stored fasting blood samples taken at baseline were analyzed for levels of the various biomarkers. The average follow-up time with participants was 4.6 years.

When comparing the highest quartile with the lowest quartile, C-reactive protein was correlated with the progression of AMD, with a multivariate adjusted relative risk of 2.10 when controlling for body mass index, smoking, and other cardiovascular variables (95 percent confidence interval, 1.06-4.18; for trend, .046) and a multivariate adjusted relative risk of 2.02 when controlling additionally for anti-oxidant nutrients (95 percent confidence interval, 1.00-4.04; P for trend, .06).

Interleukin-6 was also linked to the progression of AMD, with a multivariate adjusted relative risk of 1.81 (95 percent confidence interval, 0.97-3.36; P for trend, .03).

Though smoking and obesity were found to be significantly related to C-reactive protein and Interleukin-6 levels, higher values of both were also found to be significantly related to AMD aside from these and other established risk factors.

(Arch Ophthalmol 2005;123:774-781)
Seddon JM, George S, Rosner B, Rifai N.

No Support for LPI in IOL Control

A recent study does not provide support for the benefit of laser peripheral iridotomy in the long-term intraocular pressure control of patients with pigmentary glaucoma.

Sixty patients with bilateral pigmentary glaucoma who received uniocular iridotomy were included in the study from among the retrospective analysis data contributed by members of the American Glaucoma Society. Forty-six of the patients were observed for a minimum of two years (mean 70.3 ±26 months; range 24 to 113 months), and 14 patients were observed for less than two years.

Among the 46 patients observed for two years or more, the mean IOP in the treated eyes decreased 4.0 ±5.4 mmHg, compared with 1.9 ±3.8 mmHg in the untreated fellow eyes (p=0.005). Among the 14 patients observed for less than two years, the mean IOP in the treated eyes increased 0.36 ±2.63 mmHg, compared with the fellow, untreated eyes.

The study results do not negate the benefit of LPI for patients with pigmentary glaucoma, but it does emphasize the need for a large, prospective analysis.

(J Glaucoma 2005;14:255-259)
Reistad C, Shields M, Campbell D, Ritch R, Wang J, Wand M, American Glaucoma Society Pigmentary Iridotomy Study Group.

Severe Preoperative Visual Loss and DLEK
Researchers concludeD that DLEK surgery can be successfully performed on patients with severe preoperative visual loss caused by bullous keratopathy with transfer healthy donor endothelium, clearing of the central corneal and restoring useful vision.

Six patients (four males and two females) from 49 to 75 years of age with severe bullous keratopathy and a preoperative vision range between count fingers and light perception underwent DLEK surgery. Four of the patients received DLEK in combination with vitrectomy and placement of a ciliary sulcus sutured intraocular lens, and one patient underwent cataract surgery and DLEK. At six months, vision significantly improved from count fingers or worse preop, to 20/200 in half of the patients; the other three patients achieved an improvement to 20/100 or better. At one year, three of six patients had visual acuity improvement to 20/80, 20/60, and 20/40. Patient four improved from hand motion preop to 20/40 at six months postop, maintaining that vision to the one-year visit. One patient, however, went from count fingers preop to 20/100 at six months, but recorded at 20/400 at the one-year visit.

Aside from the successful restoration of vision in those patients with bullous keratopathy, DLEK also can be successfully combined with other intraocular surgeries including vitrectomy, intraocular lens exchange, and sutured IOL surgery. The DLEK graft can to-lerate later intraocular surgery performed as early as three months post donor tissue placement. 

(Cornea 2005;24:587-592)
Amayem A, Terry M, Helal M, Turki W, El-Sabagh H, El-Gazayerli E, Ousley P. 

Cataract Extraction and Glaucoma Visual Fields
Researchers in Nova Scotia reported that even though there was an improvement in best-corrected visual acuity after cataract surgery, the changes noted in the visual fields of the study patients as a group were negligible.

The sample group consisted of 34 eyes of 26 patients (mean ±SD age, 69.2 ±10.8 years). Thirty (88 percent) of the 34 eyes underwent phacoemulsification cataract surgery with intra-ocular lens implantation, while 4 (12 percent) underwent phacoemulsification cataract surgery with IOL im-plantation and trabeculectomy.

The mean logMAR best-corrected visual acuity improved significantly by two Snellen lines after surgery (p<.001). However, the average change in mean deviation was less than 0.1 db and not statistically significant (p=.85). Researchers noted that a potential weakness in the study was the lack of clinical grading of cataracts. They therefore suggested that further prospective controlled studies with a clearly defined and standardized grading system for cataract are necessary to determine and interpret the effect of different kinds of cataracts on the visual field in the entire range of patients with glaucoma. 

(Arch Ophthalmol 2005;123:929-932)
Carrillo M, Artes P, Nicolela M, LeBlanc R, Chauhan B.