Effect of flurbiprofen on the reduction of intraocular pressure after administration of 1% apraclonidine in patients with glaucoma.
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Clonidine↗
Biomedical subjects
J S Lustgarten
Publications and source records attributed to J S Lustgarten.
Intraocular pressure reduction with PhXA34, a new prostaglandin analogue, in patients with ocular hypertension.
In a randomized, double-masked, parallel study, one drop of 0.003% (1 microgram; n = 9) or 0.01% (3 micrograms; n = 10) PhXA34, a new phenyl-substituted prostaglandin F2 alpha analogue (13,14-dihydro-15[R,S]-17-phenyl-18,19,20-trinor-prostaglandin F2 alpha-1-isopropyl ester), or its vehicle (n = 10) was applied topically twice daily for 6 days to one eye in each of 29 patients with ocular hypertension. Compared with either baseline, contralateral, or vehicle control values, PhXA34 caused a significant (P < .001) dose-dependent reduction of intraocular pressure. The reduction lasted at least 12 hours after each drop and 24 to 48 hours after the last drop, with a significant (P < .0001) mean +/- SEM reduction of as much as 10 +/- 1 mm Hg (40%). Conjunctival hyperemia was not produced by 0.003% PhXA34, but was noted in some eyes treated with 0.01% PhXA34, and after repeated tonometry with either concentration. The prostaglandin analogue did not produce clinically obvious miosis, anterior chamber flare or cellular response, or any subjective adverse effects. PhXA34 is a potent, effective, and well-tolerated ocular hypotensive agent based on our results in this small, short-term study. Its potential as a new drug for glaucoma therapy warrants further investigation in long-term, larger studies.
Adult↗
A clinical trial of metipranolol, a noncardioselective beta-adrenergic antagonist, in ocular hypertension.
In randomized, double-masked fashion, 24 volunteers with ocular hypertension received 0.3% or 0.6% metipranolol, a noncardioselective beta blocker; or placebo twice daily to both eyes for six weeks. Intraocular pressure (mean +/- SEM) was reduced (P = .01) in the metipranolol-treated patients (baseline measurement, 25.9 +/- 0.5 mm Hg to 18.1 +/- 1.2 mm Hg at six weeks, 0.6% concentration; baseline measurement, 27.1 +/- 0.4 mm Hg to 21.6 +/- 1.5 mm Hg at six weeks, 0.3% concentration). Intraocular pressure was not markedly changed in placebo-treated patients. Outflow facility was unaltered two hours after instillation of metipranolol at study week 2 compared to baseline measurement. Aqueous humor flow rates were reduced (P = .02) 20% after 0.6% or 0.3% metipranolol instillation and were unchanged after placebo administration compared to baseline measurement. Mean systolic blood pressure, diastolic blood pressure, and pulse rate were not markedly altered. Metipranolol reduces intraocular pressure by suppressing aqueous humor flow rates.
Aged↗
MK-927, a topical carbonic anhydrase inhibitor. Dose response and reproducibility.
We investigated the dose-response and reproducibility of the intraocular pressure-lowering effect of MK-927 in ocular hypertensive patients. Patients were enrolled until at least 8 "marked responders" (peak reduction in intraocular pressure comparing the MK-927-treated eye with the placebo-treated eye greater than or equal to 6 mm Hg) and 7 "mild responders" (peak reduction in intraocular pressure comparing the MK-927-treated eye with the placebo-treated eye less than or equal to 3 mm Hg) were identified. In part A, 27 patients received one drop of 2% MK-927 in one eye (baseline mean +/- SEM intraocular pressure, 28.0 +/- 1.0 mm Hg) and placebo in the contralateral eye. Intraocular pressure was measured at baseline and 1, 2, 3, 4, and 6 hours. Maximum reduction in intraocular pressure was 4.0 +/- 0.8 mm Hg at 3 hours, with a duration of 4 hours. Ten patients were identified as marked responders and 7 as mild responders. In part B, 8 of the marked responders entered a four-period crossover study and received 2%, 0.5%, and 0.125% MK-927 and placebo in the same treated eye as in part A, and placebo in the contralateral eye. The 7 mild responders in part C received 2% MK-927 in a similar fashion as in part A. MK-927 in concentrations of 0.125% and 0.5% had little or no effect on intraocular pressure in patients with a marked response to 2% MK-927. Within-patient variability in peak response to single doses of 2% MK-927 was substantial (coefficient of variation of 0.3 and 0.5 for marked responder and mild responder groups, respectively.
Administration, Topical↗
Maintained reduction of intraocular pressure by prostaglandin F2 alpha-1-isopropyl ester applied in multiple doses in ocular hypertensive and glaucoma patients.
In a randomized, double-masked, placebo-controlled study, 0.25 microgram (n = 11) or 0.5 microgram (n = 13) of prostaglandin F2 alpha-1-isopropyl ester (PGF2 alpha-IE) was applied topically twice daily for 8 days to one eye of ocular hypertensive or chronic open-angle glaucoma patients. Compared with contralateral, vehicle-treated eyes, PGF2 alpha-IE significantly (P less than 0.05) reduced intraocular pressure (IOP), beginning 4 hours after the first 0.5-microgram dose and lasting at least 12 hours after the fourteenth dose, with a significant (P less than 0.005) mean reduction of 4 to 6 mmHg maintained throughout the last day of therapy with either dose. A contralateral effect was not observed. Mean tonographic outflow facility was significantly (P less than 0.05) higher in PG-treated compared with vehicle-treated eyes (0.17 +/- 0.02 versus 0.12 +/- 0.01 microliter/minute/mmHg, respectively; +/- standard error of the mean) for the 0.5 microgram dose. Conjunctival hyperemia reached a maximum at 30 to 60 minutes after PGF2 alpha-IE application. Some patients reported mild irritation lasting several minutes after some doses. Visual acuity, accommodative amplitude, pupillary diameter, aqueous humor flare, anterior chamber cellular response, Schirmer's test, pulse rate, and blood pressure were not significantly altered. Our findings show that PGF2 alpha-IE is a potent ocular hypotensive agent and a promising drug for glaucoma therapy.
Aged↗
Long-term reduction of intraocular pressure after repeat argon laser trabeculoplasty.
Thirty-eight eyes (in 31 patients with glaucoma) that had shown a favorable response to an initial argon laser trabeculoplasty had a repeat laser trabeculoplasty four to 81 months (mean +/- S.E.M., 23 +/- 3 months) later because of inadequately controlled intraocular pressures. A mean (+/- S.E.M.) of 65 +/- 3 burns (range, 50 to 115) were given during the initial laser trabeculoplasty, and 58 +/- 2 burns (range, 36 to 100) were given during the first repeat treatment. Three months after the first repeat laser trabeculoplasty, one eye (3%) had undergone filtering surgery and 30 eyes (78%) were considered successes. Of the 30 eyes that were followed up for 12 months after the first repeat laser trabeculoplasty, two (7%) had undergone filtering surgery, three (10%) had received a second repeat laser trabeculoplasty, and 22 (73%) were successes. Fifteen eyes underwent a second repeat laser trabeculoplasty at six to 47 months (mean +/- S.E.M., 21 +/- 3 months) after the first repeat laser trabeculoplasty. Seven (47%) of these eyes required filtering surgery within three to 12 months after the second repeat laser trabeculoplasty. Four of 38 (11%) of the initial, two of 38 (5%) of the first repeat, and zero of 15 of the second repeat laser trabeculoplasty treatments resulted in a one- to two-hour rise in intraocular pressure of at least 10 mm Hg.
Adult↗
Topical timolol-induced arthropathy.
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Female↗
Electrophysiological evidence that early glaucoma affects foveal vision.
The pattern electroretinogram (PERG) and visual evoked potential (PVEP) were recorded simultaneously using a 1.1 cpd pattern which was counterphase modulated at 1 Hz. The responses of ocular hypertensive (OHT) eyes (with normal visual fields) and eyes with early glaucoma (with early visual field defects and/or early cupping of the optic nervehead) were compared to age-matched normal observers. All patients (26 eyes) and normal observers (14 eyes) had normal transient flash electroretinograms. Delays were seen in mean PERG latency in both OHT and early glaucoma eyes, while mean PERG amplitude was significantly reduced only in the early glaucoma eyes. The PVEP responses were 'unmeasurable' in 11/26 patient eyes because the waveforms were grossly abnormal in shape, making it impossible to identify the N- and P-components. The data were categorized in this manner: a patient response was considered abnormal if latency or amplitude exceeded normal limits (PERG or PVEP) or if the waveform was 'unmeasurable' due to its shape (PVEP only). Of the 26 patient eyes, we found that 8 eyes had normal PERG and PVEP, 11 eyes had abnormal PERG and PVEP, one eye had an abnormal PERG and a normal PVEP, and 6 eyes (3 patients) had a normal PERG and an abnormal PVEP. These data support the proposition that foveal vision (as assessed by the PVEP) may be affected by early glaucomatous damage. The relationship between the PERG and PVEP also was evaluated using a new measurement which we call the 'latency window'. Using this measurement, 15/26 patient eyes were abnormal-9 of these had 'unmeasurable' PVEPs. This measurement could be useful in classifying 'W'-shaped PVEPs as normal or abnormal.
Adult↗
Betaxolol in patients with glaucoma and asthma.
We evaluated the use of topically administered betaxolol, a cardioselective beta-adrenergic blocking agent, in 11 patients (eight women and three men, 40 to 81 years old) who had asthma and severe glaucoma with increased intraocular pressure despite maximally tolerated medical therapy. In each of these patients, timolol was either contraindicated or had previously led to development of pulmonary symptoms or complications. Before betaxolol, mean forced expiratory volumes in one second were 66% in the men and 80% in the women of reported normal values in age- and height-matched groups. Betaxolol was then topically administered twice daily. All patients continued to administer betaxolol without exacerbation of pulmonary symptoms and without deterioration in measured pulmonary function tests. Betaxolol further reduced intraocular pressure by a mean of 18% (4 mm Hg) when added to the patients' otherwise maximal regimen.
Administration, Topical↗
Comparison of standard and computerized tonography instruments on human eyes.
We compared the outflow facility coefficient results after indentation tonography obtained with a standard tonography unit and with a new computerized tonography machine. Goldmann applanation tonometry was followed by standard tonography on one eye and computerized tonography on the other. After a one-hour equilibration period, tonometry was repeated and followed by tonography with the testing units used on the opposite eyes. In nine of 60 eyes the results were discarded because of poor tracings or high error. Results of initial indentation intraocular pressure measured by the two units were not statistically different from those measured by Goldmann applanation tonometry. Mean outflow facilities determined by the standard unit and by the computerized machine with the average scleral rigidity program showed no statistically significant difference by the paired t-test.
Aqueous Humor↗
The effect of corynanthine on intraocular pressure in clinical trials.
A single drop, dose-response, double-masked study of the effect corynanthine, a selective alpha 1 adrenergic antagonist, on intraocular pressure (IOP) was carried out in 10 symmetrically ocular hypertensive patients. Corynanthine 1% had no significant pressure lowering effect. Topical application of a 2% solution significantly (P less than 0.05) reduced IOP for at least eight hours; at five hours, mean IOP (+/- SEM) was 20.6 +/- 2.0 mmHg and 26.0 +/- 4.9 mmHg, comparing treated and control eyes, respectively. The 5% solution caused a significant (P less than 0.05) bilateral reduction in IOP, comparing treated and control eyes to baseline IOP respectively. Two percent corynanthine applied topically two or three times daily for one, two, or three weeks to seven patients with symmetrical ocular hypertension did not reduce IOP. Alpha adrenergic antagonists may have a role in the treatment of glaucoma.
Adrenergic alpha-Antagonists↗
Topical timolol and the nursing mother.
A 34-year-old nursing woman with elevated intraocular pressure voluntarily and without our knowledge applied 0.5% timolol maleate twice daily to her right eye. A milk sample 1.5 hours after administration of drug showed a much higher level of timolol (5.6 ng/mL) than a plasma sample drawn at the same time (0.93 ng/mL). Three control milk specimens showed no measurable levels of timolol. The patient's milk sample 12 hours after her last timolol dose contained 0.5 ng/mL of timolol. On the basis of our calculations, timolol should be used with caution by nursing mothers.
Administration, Topical↗
An unusual presentation of isolated optic nerve sarcoidosis.
A 32-year old diabetic female had unilateral reduced vision (20/30) in an eye having the ophthalmoscopic appearance of papillophlebitis of the optic nerve head. After an apparently benign course, with recovery, the optic disc became edematous again and a central retinal vein occlusion blinded the eye. Thereafter, an avascular bilobed mass progressively protruded from the optic nerve head. Computerized tomography demonstrated uniform thickening of the optic nerve from the globe through the optic canal. The radiographic appearance was consistent with an optic nerve glioma or meningioma. Spinal fluid, chest x-ray, and serum angiotensin converting enzyme activity were normal. Tuberculin skin test was positive. Optic nerve biopsy demonstrated a noncaseating granuloma and a subsequent Kveim test was positive. Isolated optic nerve sarcoidosis may exist without other systemic manifestations. The appearance on computerized tomography may be similar to that of an optic nerve glioma or meningioma.
Adult↗