Biomedical subjects

Marcos P Avila

Publications and source records attributed to Marcos P Avila.

7 recordsLinked to original sources

PubMed2006

Efficacy of latanoprost or fixed-combination latanoprost-timolol in patients switched from a combination of timolol and a nonprostaglandin medication.

PURPOSE: To compare latanoprost with the fixed-combination latanoprost-timolol in glaucoma or ocular hypertension patients switched from a combination glaucoma therapy with timolol and another nonprostaglandin medication. DESIGN: Prospective randomized clinical trial. METHODS: Glaucoma or ocular hypertension patients receiving a combined treatment of timolol 0.5% and another nonprostaglandin medication (pilocarpine 4%, alpha-agonist, or a topical carbonic anhydrase inhibitor) underwent a 30-day washout of their medications. A masked observer then measured their intraocular pressure (IOP). The subjects were randomized to either latanoprost or fixed-combination latanoprost-timolol eyedrops to use once daily at 7 am. The IOP was measured again 30 days after the patients started using one of the study drugs by the same examiner at the same time. MAIN OUTCOME MEASURE: Comparison of the study medications' hypotensive effect. RESULTS: Fifty-three eyes (28 in the latanoprost group and 25 in the latanoprost-timolol group) from 28 patients were included in the study. The IOP reduction was greater in both study groups compared with the previous combination therapy with timolol and another nonprostaglandin medication in millimeters of mercury (7.7+/-2.3 vs. 5.5+/-2.3, P<0.001, for the latanoprost group; 8.5+/-3.5 vs. 6.3+/-2.7, P<0.001, for the latanoprost-timolol group) and percentage (35.8+/-8.2% vs. 25.6+/-8.9%, P<0.001, for the latanoprost group; 38.6+/-8.7% vs. 28.6+/-9.0%, P<0.001, for the latanoprost-timolol group). There was no statistical difference between latanoprost and fixed-combination latanoprost-timolol in reducing IOP, in either millimeters of mercury (P = 0.3) or percentage (P = 0.2). CONCLUSIONS: Both latanoprost and fixed-combination latanoprost-timolol may be viable substitutes for timolol and another nonprostaglandin medication in glaucoma or ocular hypertension patients.

Adult↗

PubMed2006

A randomized, investigator-masked, 4-week study comparing timolol maleate 0.5%, brinzolamide 1%, and brimonidine tartrate 0.2% as adjunctive therapies to travoprost 0.004% in adults with primary open-angle glaucoma or ocular hypertension.

OBJECTIVE: The objective of this study was to assess the hypotensive efficacy of timolol maleate 0.5%, brinzolamide 1%, or brimonidine tartrate 0.2% ophthalmic solution, administered in conjunction with travoprost 0.004%, in patients with primary open-angle laucoma (OAG) or ocular hypertension (OHT) whose intraocular pressure (IOP) did not meet the treatment target using travoprost 0.004% monotherapy. METHODS: This was a randomized, comparative, investigator-masked study. Patients with OAG or OHT treated with travoprost 0.004% monotherapy were randomized to receive 1 of the 3 adjunctive therapies (timolol maleate 0.5%, brinzolamide 1%, or brimonidine tartrate 0.2%), 1 drop BID in each randomized eye, in addition to 1 drop QD of travoprost for a period of 4 weeks. IOP was measured on days 0 (travoprost 0.004%) and 28 (travoprost 0.004% and adjunctive treatment). Adverse events were monitored on days 0 and 28 by patient interview. RESULTS: Twenty-nine patients with OAG (46 eyes) and 3 patients with OHT (6 eyes), with a total of 52 eligible eyes, completed the study; 28 eyes were from male patients and 24 were from female patients. In addition to continuing travoprost treatment, 20 eyes received timolol, 16 eyes received brinzolamide, and 16 eyes were treated with brimonidine. There were no significant differences among the groups in the mean (SD) IOP at baseline on day 0 (19.0 [4.1], 17.2 [3.5], and 17.0 [3.1] mm Hg, respectively; P=NS). On day 28, the reduction in mean (SD) IOP in eyes treated with brimonidine tartrate 0.2% was significantly smaller (2.3 [1.8] mm Hg vs 3.9 [1.8] mm Hg [P=0.01]) and the mean (SD) percentage reduction in IOP was significantly smaller (13.4% [9.1%] vs 20.2% [7.5%] [P=0.01]) when compared with timolol maleate 0.5%, and likewise when compared with brinzolamide 1% (4.0 [2.1] mm Hg [P=0.02] and 22.7% [8.6%] [P=0.006], respectively). The group treated with brinzolamide was associated with a similar reduction in IOP to timolol (P=NS for both mean [SD] IOP and percentage reduction in IOP compared with timolol monotherapy). Barring the occasional conjunctival hyperemia, which was excluded as an adverse event for the purposes of this study, no adverse events were recorded. CONCLUSION: Brinzolamide 1% and timolol maleate 0.5% treatment were both associated with a significantly greater reduction in IOP compared with brimonidine 0.2% when administered as a nonfixed adjuvant to travoprost 0.004% in the treatment of patients with OAG and OHT whose IOP was inadequately controlled with travoprost monotherapy. All treatments were well tolerated.

Adrenergic alpha-Agonists↗

PubMed2004

Ibopamine provocative test and glaucoma: consideration of factors that may influence the examination.

PURPOSE: To evaluate factors that may influence the ibopamine provocative test for the diagnosis of glaucoma. METHODS: Two Ibopamine (3,4 di-isobutyrylester of N-methyldopamine) 2% eyedrops were instilled 5 minutes apart in one eye selected at random in both glaucoma and normal subjects. The intraocular pressure (IOP) was assessed prior to the drops and 30, 60 and 180 minutes after instillation. The test was considered positive when there was an IOP increase of greater than 4 mmHg at any one of the timepoints. The amount of IOP change was compared to the severity of glaucomatous visual field loss and to the types of medical treatment. RESULTS: The sensitivity (glaucoma patients with a positive result) and specificity (normal individuals with a negative result) of the Ibopamine test was 87 and 95%, respectively. Glaucoma patients using prostaglandin analogues did not have a significant IOP elevation. CONCLUSION: The Ibopamine provocative test may be an auxiliary test in glaucoma diagnosis. Concurrent use of prostaglandin analogues reduces the test's sensitivity.

Adult↗

PubMed2004

Quality of life in glaucoma patients: regression analysis and correlation with possible modifiers.

PURPOSE: To verify the quality of life in a Brazilian glaucoma population and the influence of possible modifiers (e.g., visual acuity, visual field impairment). METHODS: Forty-five consecutive patients from CEROF - Federal University of Goias, Brazil were included prospectively in the study. The quality of life was assessed using the Portuguese version of the VFQ. Possible modifiers were evaluated, initially separately with the Spearman's Correlation and then together in a regression model. RESULTS: The mean age was 59.6 +/- 12.4 years. The mean quality of life score was 79 +/- 15 (range 45-100). Age (r = -0.402, p = 0.006), visual acuity in the better eye (r = -0.497, p = 0.001) and in the worse eye (r = -0.608, p < 0.001), Hodapp-Parrish-Anderson visual field grading scale in the better (r = -0.353, p = 0.01) and worse eye (r = -0.387, p = 0.009), visual field Mean Deviation (MD) in the better (r = 0.355, p = 0.01) and worse eye (r = 0.320, p = 0.04) and ability to perform a visual field test in both eyes (r = -0.397, p = 0.007) were significantly correlated with the quality of life scores. However, only age (younger, better quality of life, p = 0.008) and visual acuity in the better eye (direct relation, p = 0.04) were significant in the regression model (r = 0.633, r(2) = 0.401). CONCLUSIONS: The VFQ may be a useful tool to assess the quality of life in glaucoma patients. The preliminary results indicate that age and visual acuity in the better eye are the main factors related to the quality of life in these patients.

Age Factors↗

PubMed2004

A prospective, comparative study between endoscopic cyclophotocoagulation and the Ahmed drainage implant in refractory glaucoma.

PURPOSE: To compare endoscopic cyclophotocoagulation (ECP) and the Ahmed drainage implant in the treatment of refractory glaucoma. METHODS: Sixty-eight eyes of 68 patients with refractory glaucoma were prospectively assigned to either ECP or Ahmed tube shunt implantation. All procedures were performed by a single surgeon. Eyes that were included were pseudophakic with a history of at least one trabeculectomy with antimetabolite, an intraocular pressure (IOP) equal to or above 35 mm Hg on maximum tolerated medical therapy, and a visual acuity better than light perception. Exclusion criteria included eyes that had had previous glaucoma drainage device implantation or a cyclodestructive procedure. Success was defined as an IOP more than 6 mm Hg and less than 21 mm Hg, with or without topical anti-hypertensive therapy. RESULTS: The mean follow-up was 19.82 +/- 8.35 months and 21.29 +/- 6.42 months, for the Ahmed and ECP groups, respectively (P = 0.4). The preoperative IOP, 41.32 +/- 3.03 mm Hg (Ahmed) and 41.61 +/- 3.42 mm Hg (ECP) (P = 0.5), and the mean postoperative IOP, at 24 months follow-up, 14.73 +/- 6.44 mm Hg (Ahmed) and 14.07 +/- 7.21 mm Hg (ECP) (P = 0.7), were significantly different from baseline in both groups (P < 0.001). Kaplan-Meier survival curve analysis showed a probability of success at 24 months of 70.59% and 73.53% for the Ahmed and ECP groups, respectively (P = 0.7). Complications included choroidal detachment (Ahmed 17.64%, ECP 2.94%), shallow anterior chamber (Ahmed 17.64%, ECP 0.0%), and hyphema (Ahmed 14.7%, ECP 17.64%). CONCLUSION: There was no difference in the success rate between the Ahmed Glaucoma Valve and ECP in refractory glaucoma. The eyes that underwent Ahmed tube shunt implantation had more complications than those treated with ECP.

Ciliary Body↗

PubMed2002

Identifying live nematodes in diffuse unilateral subacute neuroretinitis by using the scanning laser ophthalmoscope.

OBJECTIVE: To describe use of the scanning laser ophthalmoscope (SLO) to identify live nematodes in patients with diffuse unilateral subacute neuroretinitis. METHODS: Infrared, red, and blue illumination (780, 633, and 488 nm, respectively) in an SLO were used to image and evaluate functional retinal status in patients with late-stage diffuse unilateral subacute neuroretinitis. An examination to identify live nematodes was performed in the affected eyes. RESULTS: Using blue illumination, the ocular fundus appeared dark and provided a high-contrast background for the white image of the worm. The red laser was used to perform red-on-red perimetry. We also used perimetry stimulus to stimulate the worm's movement and pinpoint its location. We precisely defined the relation between the fixation point and the worm to plan accurate laser treatment. The infrared laser is safe and comfortable for prolonged examination. Using the SLO, several physicians simultaneously visualized the ocular fundus. Video output from the SLO provided temporal information, excellent for enhancing detection of worms, which was displayed dynamically on video. CONCLUSIONS: Although examination with a fundus contact lens by skilled ophthalmologists is the method of choice, the SLO provides a new examination modality with distinct advantages for identifying live worms in young patients with diffuse unilateral subacute neuroretinitis.

Adolescent↗

PubMedDate not supplied

Interventions in pseudophakic rhegmatogenous retinal detachment.

With refinement of vitrectomy techniques over the past 30 years, the treatment of rhegmatogenous retinal detachment (RRD) has transitioned from the almost exclusive use of extraocular techniques to the present time in which intraocular interventions are available and, in some practices, enjoy almost exclusive use for primary repair of RRD. Except for those situations in which a retinal detachment is associated with obvious immediate complications related to the cataract surgery, the considerations for the treatment of pseudophakic RRD are quite similar to those of phakic RRD. The current options are: use of an extraocular buckling device, vitrectomy-related procedures, intraocular gas injection with associated retinopexy, and combinations of these. Disagreement on the ideal intervention for pseudophakic retinal detachment is not uncommon and particularly so in those RRDs which lie somewhere in the spectrum between complex and simple. As is so often the case in the surgical treatment of disease, there may not be one ideal technique for a particular type of RRD; but knowledge of alternatives logically increases the likelihood of a successful result. The goal of this paper is to outline the clinical factors shown to be of importance in deciding which technique will have the greatest chance at not only achieving retinal re-attachment but also in optimizing long-term vision.

Cataract Extraction↗