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In a controlled double-blind cross-over trial in 10 patients comprising six with open-angle glaucoma, three with closed-angle glaucoma, and one with ocular hypertension, a single oral dose of atenolol (50 mg) was significantly more effective than propranolol (40 mg) in reducing ocular tension.
Pilocarpine 4% solutions at pH 4.1 and 5.8 were compared in a double-blind clinical trial on 24 eyes of patients with primary open-angle glaucoma. Each drug was used over a period of 1 week. No significant difference in the lowering of intraocular pressure was found, and the near-neutral solution of pilocarpine was found to be equally stable when compared to the acid solution over a 6-month period.
Thirty eyes of 15 patients with open-angle glaucoma were followed up for a period of up to 1 year while being treated with Piloplex eye drops containg a new long-acting pilocarpine polymer salt. Average morning intraocular pressure (IOP) values during treatment with pilocarpine hydrochloride administered 4 times daily was 20.5 mmHg. Average morning IOP values during Piloplex medication administered only twice daily were 19.8 to 18.2 mmHg (range of averages on 14 sessions). These findings indicate the lower average pressure during Piloplex medication and show its prolonged hypotensive effect. Both medications contained an equivalent total daily amount of pilocarpine. Throughout the 1-year study period no adverse side effects were reported, and only 1 patient complained of local sensitivity reaction. Visual disturbances characteristic of pilocarpine eye drops were reduced from 3 times a day on pilocarpine hydrochloride 4 times daily to once a day on Piloplex twice daily.
A study of the postoperative evolution of 70 eyes subjected to trabeculectomy over a 3-year period is reported. This is the operation of choice in our department in cases of chronic open-angle glaucoma and chronic angle-closure glaucoma. The study showed that in 35.7% of the operated eyes the intraocular pressure was increased on the second postoperative day and became normal within a week. This raised intraocular pressure did not influence the final result of the operation.
In the scope of a clinical-experimental study on 12 patients with chronic open-angle glaucoma we proved that a reduction in the individual doses of Acetazolamide (Diamox) brought no reduction in the effect on raised intraocular pressure when the frequency of application was the same. Daily doses of 3 X 125 mg were compared with those of 3-250 mg and 2 X 500 mg (Retardform). A additional trial on 6 patients with a daily dose of 3 X 62.5 mg also showed an obvious effect. The possibilities of long term treatment with acetazolamide are discussed.
Various surgical treatment methods were outlined that are currently used in treatment of the severe chronic contractual changes seen in Stevens-Johnson syndrome and ocular pemphigoid. All methods described are not 100% successful in view of the chronicity of the disease, but have greatly aided in delaying the destructive course of action because of various degrees of cicatricial entropion formation. The potential association of ocular pemphigoid with Phospholine Iodide medications in the treatment of open-angle glaucoma is under investigation.
Dipivalyl epinephrine, an epinephrine derivative, has been developed to improve the pharmacokinetic properties of the compound. Our open-label investigation included the administration of dipivalyl epinephrine ophthalmic solution to the eyes of 33 patients with an open-angle glaucoma. Former topical medication of parasympathomimetic agents was continued. The 0.1% dipivalyl epinephrine treatment approximated the results obtained with 1% epinephrine borate or phenylephrine 5% in reducing the intraocular pressure.
In a study lasting 16 months, Timolol was tested on 57 eyes of a group of selected patients with open-angle glaucoma. Patients whose IOP could not be stabilized with the 0.25% solution were treated with 0.5% drops twice a day. In five separate cases, where regulation was inadequate, pilocarpine 2% twice a day was prescribed in addition. At the end of 16 months' treatment pressure had been lowered to a statistically highly significant degree in 66% of the patients. While the degree of regulation in the remainder was not statistically sifnificant, most of them were adequately stabilized. Further, following stabilization with Timolol, 42% of the patients were subjected to tolerance tests under constant conditions (darkness test, water test, coffee and tea tolerance) and their 6.00 a.m.values were measured. While good pressure levels were recorded in the tolerance tests, the early-morning IOP rose to critical threshold levels in some patients. However, during the entire period of observation visual fields and optic disk findings remained unaltered in all cases. Only a few cases were subjective and/or objective side-effects seen. Ten percent of those patients who had been treated previously required new glasses (+0,5 to +1 D over the previous correction).
Clinical studies were conducted to determine the relationship between simultaneous changes in heart rate, blood pressure, and intraocular pressure in systemic normotensive (N=8) and hypertensive (N=8) open-angle glaucoma patients (N=16) after inhalation of tetrahydrocannabinol (THC). Insignificant changes occurred in arterial and ocular pressures after placebo pertubations. The functional responses after 2.8% THC inhalation in sitting normotensive and hypertensive patients included invariable increases in heart rate (range 20-62 beats/min greater than control) followed by substantial decreases in systolic pressure (range 12-52 mmHg less than control), diastolic pressure (range 6-28 mmHg less than control), and intraocular pressure (range 6-21 mmHg less than control). The intensity and duration (3-4 hours) of the arterial and ocular pressure responses to THC were greater in hypertensives than in normotensive patients. The salient observation after THC inhalation was that the changes in ocular pressure paralleled the changes in blood pressure in each glaucoma patient. These findings suggest that the positive chronotropic response to THC tends to maintain cardiac output which limits further decreases in blood pressure and the capillary filtration of aqueous humor decreases or the reabsorption of aqueous humor increases because of the systemic hypotensive effect attending THC inhalation.
A 50-year-old black man with uncontrolled open-angle glaucoma developed a flat anterior chamber after cyclocryotherapy. Because of poor visualization secondary to a cataract, ultrasonography was used to confirm the diagnosis of a large choroidal detachment. After suprachoroidal drainage and reformation of the anterior chamber, the patient has done well.
The ability to demonstrate AMPS in the trabecular region in the normal eye of the Rhesus monkey was shown to be critically dependent upon technical variation. Staining the fixed specimen prior to dehydration and embedding permits the uniform demonstration of AMPS in the trabecular region of the Rhesus monkey and shows it to be hyaluronidase-sensitive. Electron microscopy using the modified technique shows the reaction products to be present within the trabecular band, the intertrabecular spaces, and the canal of Schlemm. More impressive distribution was seen in the basement membrane of trabecular endothelium intimately related to the cell wall and in the ground substance and basement membrane of the endothelium of the inner wall of the canal Schlemm. The technique is also successful in the human eye and suggests a greater abundance of trabecular AMPS in open-angle glaucoma.
In 22 open-angle glaucoma patients a total of 39 eyes were treated with Timolol 0.25% twice daily for an average period of 12.6 months. The relative intraocular pressure decrease at the beginning of the study was 47% of the untreated pressure level. This initial response declined to a 23% pressure decrease at the end of the study. In 8 eyes treatment had to be discontinued because of insufficient pressure control and in one patient because of subjective intolerance. In two patients (4 eyes) a complete loss of response of Timolol therapy was observed. The phenomenon of slowly diminishing drug effectiveness was not related to the untreated pressure levels in the patients covered by this study. In 5 eyes there was evidence of a rebound effect after discontinuation of Timolol therapy.
INTRODUCTION: The purpose of this study was to evaluate the capabilities of large language models such as Chat Generative Pretrained Transformer (ChatGPT) to diagnose glaucoma based on specific clinical case descriptions with comparison to the performance of senior ophthalmology resident trainees. METHODS: We selected 11 cases with primary and secondary glaucoma from a publicly accessible online database of case reports. A total of four cases had primary glaucoma including open-angle, juvenile, normal-tension, and angle-closure glaucoma, while seven cases had secondary glaucoma including pseudo-exfoliation, pigment dispersion glaucoma, glaucomatocyclitic crisis, aphakic, neovascular, aqueous misdirection, and inflammatory glaucoma. We input the text of each case detail into ChatGPT and asked for provisional and differential diagnoses. We then presented the details of 11 cases to three senior ophthalmology residents and recorded their provisional and differential diagnoses. We finally evaluated the responses based on the correct diagnoses and evaluated agreements. RESULTS: The provisional diagnosis based on ChatGPT was correct in eight out of 11 (72.7%) cases and three ophthalmology residents were correct in six (54.5%), eight (72.7%), and eight (72.7%) cases, respectively. The agreement between ChatGPT and the first, second, and third ophthalmology residents were 9, 7, and 7, respectively. CONCLUSIONS: The accuracy of ChatGPT in diagnosing patients with primary and secondary glaucoma, using specific case examples, was similar or better than senior ophthalmology residents. With further development, ChatGPT may have the potential to be used in clinical care settings, such as primary care offices, for triaging and in eye care clinical practices to provide objective and quick diagnoses of patients with glaucoma.
This is a study of 59 patients, 42 with glaucoma and 17 with neurological disease, to compare the Octopus automated perimeter with the conventional Goldmann and Tubinger perimeters for detection and assessment of visual field defects. We believe the Octopus automated perimeter is an excellent method for screening patients suspected of glaucoma and can be expected to identify over 90% of the patients actually having visual field loss due to glaucoma. In patients with neurological disease, the Goldmann perimeter was superior to either the Octopus or Tubinger perimeters in providing clinically useful information.
Pseudoexfoliation glaucoma is a severe form of secondary open angle glaucoma and is associated with activation of the TGF-β pathway by TGF-β1. MicroRNAs (miRNAs) are small non-coding RNA species that are involved in regulation of mRNA expression and translation. To investigate what glaucomatous changes occur in the trabecular meshwork and how these changes may be regulated by miRNAs, we performed a bioinformatics analysis resulting in a miRNA-mRNA interactome. Primary human trabecular meshwork cells originating from normal donors were treated with TGF-β1 at 5 ng/mL for 24h; total RNA was extracted followed by RNA-Seq and miRNA-Seq. For both mRNA and miRNA species, differential expression was determined using a bioinformatics pipeline consisting of FastQC, STAR, FeatureCounts, edgeR (for miRNA) and DESeq2 (for mRNA). Putative mRNA-miRNA interactions between differentially expressed mRNA and miRNA species were determined using interaction databases miRWalk, miRTarBase, TarBase and TargetScan. To classify mRNA species by function and pathway, gene enrichment was performed using Enrichr. The resulting miRNA-mRNA interactome consisted of 1202 interactions. Some highly connected microRNAs were hsa-let-7e-5p, hsa-miR-20a-5p, hsa-miR-122-5p, and hsa-miR-29c-3p. Most differentially expressed genes were indicated to be regulated by miRNAs. The sub-interactomes of genes involved in specific pseudoexfoliation glaucoma related enrichment terms such as oxidative stress, unfolded protein response, signal molecules and ECM remodelling were determined. This is the first study to present a genome-wide microRNA-mRNA regulatory network for human trabecular meshwork cells treated with TGF-β1 and may serve to generate unbiased hypotheses about regulatory functions and mRNA targets of miRNAs in pseudoexfoliation glaucoma and may help to develop miRNA-based therapeutics.
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One hundred fifty-one eyes of 101 consecutive patients with chronic open-angle and low tension glaucoma showed typical visual field changes. Sixty of the eyes had a nasal step, either alone or in combination with other defects. In 17 of these eyes, it was possible to demonstrate an isolated scotoma in the nasal periphery. It was concluded that the peripheral nasal step is a nerve fiber bundle defect that in its earliest phase produces a scotoma. In this sense, it behaves similar to the more central defects, rather than simply as a depression of isopters nasally.