Clinical study on the effects of loteprednoletabonate 0.5%/Tobramycin 0.3% eyedrops after lamellar corneal refractive surgery
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Abstract:
Objective
To observe the effects of 0.5% loteprednoletabonate/0.3% tobramycin eye drops in lamellar refractive surgery patients.
Methods
This study enrolled 158 patients, 77 cases (154 eyes) as treatment group and 81 cases (156 eyes) for control. Treatment group were treated with 0.5% loteprednoletabonate/0.3% tobramycin for 1 week, and control group with 0.1% dexamethasone/0.3% tobramycin. for 1 week.
Results
At 1 week post-surgery, the IOP 16.81±1.92 mmHg(M=17.425 mmHg)in treatment group was lower than 17.50±2.58mmHg (M=17.025 mmHg)for control(P =0.018). At 1 month, the IOP were 16.18±2.05mmHg in treatment group and 16.34±2.28mmHg for control with no difference(P =0.83). Fluorescein staining and DLK were same (P >0.05).
Conclusions
0.5% loteprednoletabonate/0.3% tobramycin. can inhibit inflammation and DLK with lower risk of IOP elevation than traditional steroids.
Key words:
Myopia; Lamellar corneal refractive surgery; SMILE; LoteprednoletabonateKeywords:
Refractive Surgery
During a 7-month period 33 patients (20 with primary open-angle glaucoma and 13 with suspected glaucoma) were treated with guanethidine 3% and adrenaline 0.5% in 1 eyedrop twice daily. The previous therapy was discontinued and the aim of the trial was to treat the patients with GA alone. There was an average decrease in intraocular pressure of 10.8 mmHg or 37.5% for the whole group (including 5 patients with additional therapy). In eyes with an average IOP in a day-curve without medication equal to or higher than 28 mmHg we found a decrease of 44.6% or 14.4 mmHg, and in eyes with an average IOP without medication between 21 and 28 mmHg a decrease of 30.4% or 7.6 mmHg. With GA alone the IOP was 3.3 to 3.9 mmHg lower than on the previous therapy (P less than 0.05); 46% of the eyes without additional therapy had all IOPs lower than 22 mmHg and 74% of the eyes had IOPs lower than 22 mmHg except 1 with a peak lower or equal to 25 mmHg 3 hours after application. This peak 3 hours after application indicates that GA has a biphasic action and was significant at the 0.5% level. Red eyes and slight ptosis were no problem for most patients. Patients found it very convenient to administer GA only twice daily.
Guanethidine
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Steroid eye drops were widely used for suppression ocular inflammation in many conditions. Unfortunately, steroid eye drops can cause many side effects; the important one was steroid-induced ocular hypertension that may progress to seconday glaucoma.To evaluate incidence ofsteroid responder following topical dexamethasone use after pterygium excision with amniotic membrane graft.Prospective descriptive study.The present study was designed to evaluate intraocular pressure (IOP) change from topical dexamethasone eye drops in postoperative pteiygium excision with amniotic membrane grafting. The subjects were routinely prescribed CD-oph (1 mg/ml dexamethasone sodium phosphate, 5 mg/nd chloramphenicol and 0.25 mg/ml Tetrahydrozaline hydrochloride) eye drops every 1 hour for 1 week, then every 2 hours until 1 month, then four times daily until 3 months postoperatively. The subjects were measured IOP at I week, 1 month, and 3 month postoperatively by applanation tonometer The steroid responder was defined as an elevation ofIOP at least 10 mmHgfrom preoperative. The incidence was calculated, trend of IOP rising and timing of peak IOP were assessed.Ofthe 62 patients, 6 were diagnosed as steroid responders (IOP >10 mmHg), 9.68% (95% CI 3.6-19.9). Mean of peak IOP rising was 4.02+/-3.18 mmHg with maximum IOP rising was 11 mmHg. 4 of 6 cases of steroid responders occur at 3 month postoperative, 2 another cases occur at 1 week and I month postoperative. Most of the subjects had IOP rising in range of 0-4 mmHg (62.90%), follow by 5-9 mmHg (2 7.42%), and > 10 mmHg (9.68%), respectively. Maximum IOP mostly in range of 16-20 mmHg (43.55%), follow by 11-15 mmHg (40.32%), 21-25 mmHg (9.68%), and more than 26 mmHg (6.45%), respectively. 45.16% of subjects showed the time of peak lOP at postoperative 1 month.Steroid response is a common problem in steroid use, especially with topical steroid eye drops. The incidence of steroid responderfrom this study was 9.68%, which may differ from the others by type, frequency of the topical steroid used, including criteria to diagnosis of steroid responder
Topical steroid
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Background: Glaucoma is one of the most common causes of blindness in dogs, and is generally characterized by death of the retinal ganglion cells associated with a rapid loss of vision. Increased intraocular pressure (IOP) occurs in patients with primary glaucoma, due to genetic abnormalities in pectinal ligaments and the trabeculae of the iridocorneal angle, producing inadequate drainage of aqueous humor. IOP is the result of the dynamic equilibrium between the production and drainage of aqueous humor. Intraocular surgery, anterior lens luxation, systemic diseases, immune-mediated, neoplastic and infectious diseases lead to the breakdown of the blood-aqueous barrier and increase the amount of protein and cells in aqueous humor, which can block this drainage pathway. Under these conditions, becomes indispensable the pharmacological control of IOP by reducing aqueous humor production. The main objective of the present study was to evaluate the effects of topical 1% brinzolamide on intraocular pressure (IOP) in twelve healthy dogs.Materials, Methods & Results: The age range of affected dogs was 1-5 years, with a mean age of 2.5 years. Twelve dogs were included in this study. All animals were healthy based on clinical, ophthalmic and hematological examinations. Selected animals were kept in a room with 500 lux luminosity, 56.8% relative humidity, 20°C temperature, exposed to 12 h of light/dark cycle, were fed twice daily and water ad libitum. All animals were adaptation to the procedures and examiners and IOP was measured by applanation tonometry at 08:00 a.m., 11:00 a.m., 02:00 p.m., 05:00 p.m., and 08:00 p.m., for 7 days and 2 days of baseline. Subsequently, one eye of each dog was randomly assigned, the eye received one drop of 1% brinzolamide at 08:30 a.m., 02:30 p.m., and 08:30 p.m. during four consecutive days and adelfo eyes received one drop of sterile saline solution and were considered control eyes. During the treatment phase and on the day after the treatment had finished, all parameters were evaluated in a blind fashion at the same pre-established time points. The value for IOP during the baseline of the treated eye were 16.77 ± 0.22 mmHg. The baseline period, values did not differ significantly between treated and control eyes. Comparison between the first day of brinzolamide-treated eyes with the average daily values of the two days of the baseline period showed that IOP decreased significantly 8.88%. IOP after four days of daily instillations of brinzolamide was able to decrease overall IOP by 1.42 mmHg (8.47%) when compared with the baseline period. Overall IOP values in the brinzolamide-treated eyes decreased 1.02 mmHg (6.24%) when compared to the control eyes. There were no statistically significant differences when compared control eye to baseline. Three times daily instillations of 1% brinzolamide in healthy dogs significantly decrease 8.47% IOP. During the post-treatment period, the average daily values of the brinzolamide-treated eyes remained 1.52 mmHg below the average daily values observed at baseline period.Discussion: The present research showed that, the average daily IOP values in the brinzolamide-treated eyes decreased 1.49 mmHg (8.88%) at the end of the first day, 1.69 mmHg (10.07%) at the end of the fourth day, and the cumulative IOP values after four days of treatment, were able to decrease by 1.42 mmHg (8.53%). Three times daily instillations of 1% brinzolamide in healthy dogs significantly decrease IOP, and therefore may be indicated to management of intraocular hypertension and glaucoma.
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Hypertonic saline
Bullous keratopathy
Topical steroid
Etiology
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Purpose To measure intraocular pressure (IOP) elevation 6 and 24 hours after phacoemulsification in patients with glaucoma and to investigate the efficacy of brimonidine tartrate 0.2% in preventing IOP rise on the first postoperative day following cataract surgery. Methods In this prospective randomized single-masked study, 86 eyes of 78 patients with well-con-trolled open-angle glaucoma were scheduled for phacoemulsification surgery. Patients were randomly assigned into 2 groups. Group A received 1 drop of brimonidine tartrate 0.2% and group B, which served as a control group, received 1 drop of artificial tears. Intraocular pressure was measured at baseline, before surgery, and 6 and 24 hours postoperatively. Results Within each group, we found a statistically significant difference in IOP between baseline and 6 hours postoperatively (p<0.01) and between 6 and 24 hours (p<0.01). There was no statistically significant difference between baseline IOP and 24-hour values. Comparing the 2 groups, there was no statistically significant difference in preoperative and 24-hour postoperative IOP. Six hours after surgery, the mean IOP in the brimonidine group was 18.52±4.58 mmHg, compared with 20.86±3.79 mmHg in the control group. Treatment with brimonidine tartrate 0.2% significantly reduced postoperative IOP elevation 6 hours following cataract extraction (p=0.009). Conclusions Patients with medically well-controlled glaucoma may experience a substantial increase in IOP shortly after phacoemulsification surgery. Instillation of brimonidine tartrate 0.2%, although it significantly reduced IOP elevation following cataract operation, did not completely prevent IOP spikes.
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Because topical brimonidine tartrate has been reported to decrease flap adherence in the early postoperative period after LASIK, its effect on the intrastromal corneal pressure (ICP) was evaluated.An interventional, prospective, animal study was performed. Intrastromal corneal pressure was recorded for 45 minutes in eight eyes of rabbits treated with topical brimonidine tartrate three times daily for 3 consecutive days (study group); eight contralateral eyes were treated with artificial tears (control group). All measurements were performed by the same, masked investigator.Mean ICP was -4.00 +/- 2.90 mmHg, -6.70 +/- 3.00 mmHg, and -9.00 +/- 4.50 mmHg at 15, 30, and 45 minutes, respectively, in the control group. In the study group (brimonidine-treated eyes), the ICP readings were +2.75 +/- 2.90 mmHg, -2.50 +/- 13.00 mmHg, and -8.50 +/- 5.00 mmHg at the same time points, respectively. The differences in the ICP between both groups were statistically significant at 15 minutes (P = .01), but no significant difference was found at 30 or 45 minutes (P = .20 and P = .80, respectively).Topical treatment with brimonidine tartrate induces a significant decrease in ICP at 15 minutes. This effect on ICP may explain the decreased corneal flap adherence reported in eyes treated with this drug.
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LASIK
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Background Laser in-situ keratomileusis (LASIK) has been widely used to correct myopia,and the glucocorticoid-induced complication is increased.Bromfenac sodium 0.1％ is a non-steroidal anti-inflammatory drug used post-LASIK,but if it is better in clinical effects,safety and tolerance than glucocorticoid is unclear.Objective This study was to evaluate the safety,effectiveness,compliance of bromfenac sodium ophthalmic solution compared with glucocortieoid following LASIK.Methods A prospective randomized controlled trail were performed.Two hundred thirty-eight myopic eyes of 119 patients for LASIK were included in Peking Union Medical College Hospital from January 2011 to May 2012.The myopic eyes were firstly assigned to moderate and low spherical equivalent (SE) group (≤-6.0 D) or high SE group(＞-6.0 D) and then were further randomized into a NSAIDs subgroup and a glucocorticoid subgroup.Bromfenac sodium ophthalmic solution 0.1％ was topically administered 4 times per day for 10 days in the NSAIDs subgroup,and 0.1％ dexamethasone eye drops was used in the same way in the glucocorticoid subgroup after the LASIK.Uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),intraocular pressure (IOP),corneal topography,clinical symptom were examined and compared between the groups 1 day,10 days,1 month,3 months and 6 months after LASIK.Results There was no statistically significant postoperative difference in visual acuity and corneal topography (K1,K2,surface asymmetry index [SAI],surface regular index [SRI] and cylinder) between the NSAIDs and control group (P＞0.05).Postoperative IOP was significantly lower than that in preoperation,and lower IOP was found in the NSAIDs group than that of the glucocorticoid group.The IOP values in the moderate and low SE subjects of the NSAIDs group and glucocorticoid group were (13.31±2.44) mmHg and (16.62±4.74) mmHg on postoperative 10 days,(12.93±2.25) mmHg and (12.82± 1.72) mmHg in 1 month,(13.83±3.08) mmHg and (13.33 ±2.10) mmHg in 3 months,(11.67 ±2.48) mmHg and (13.64± 1.37)mmHg in 6 months after operation,respectively,showing significant differences among the groups and various timepoints (Fgroup =4.067,P =0.045 ; Ftime =10.689,P =0.000 ; Finteraction =2.897,P =0.023).In the high SE subjects of the NSAIDs and glucocorticoid group,the IOP values were (12.36± 1.30) mmHg and (17.32±4.74) mmHg in postoperative 10 days,(12.10t2.12)mmHg and (14.81 ±2.26)mmHg in postoperative I month,with a significant difference among the groups and timepoints (Fgroup =2.188,P =0.121 ;Ftime =14.025,P =0.000 ;Fi tion =15.805,P=0.000).No haze or diffuse lamellar keratitis (DLK) appeared in both groups,and the epithelial flaps were wellpositioned with satisfying healing process except for one eye in the moderate and low SE eyes of the NSAIDs group.Bromfenac sodium ophthalmic solution 0.1％ was well tolerated by all patients in the NSAIDs group,but discontinuation sensation occurred in 8 eyes of 6 patients and the antiglaucoma drugs were administered due to elevated IOP in the glucocorticoid group.The refractive status remained stable for patients of the moderate and low SE group.Conclusions Bromfenac sodium ophthalmic solution 0.1％ is safe,effective and well tolerated after topically administered following LASIK,and its outcomes in recovery of visual acuity,anti-inflammation and stabilizing refractive status and IOP are satisfying.But long-term attention should be payed to the high-myopic eyes.
Key words:
Laser in-situ keratomileusis; Bromfenac sodium ophthalmic solution; Non-steroidal anti-inflammatory drug; Glucocorticoid
LASIK
Subgroup analysis
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Fundus (uterus)
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Objective
To compare the effects of topical antiglaucomatous agents on silicone oil glaucoma (SOG).
Methods
Eyes, which SOG was diagnosed at least 1 month after silicone oil tamponade, were selected for this experiment. The patients whose intraocular pressure (IOP) was 22-30mmHg, were divided randomly into two subgroups, group A1 (treated by levobunolol hydrochloride eye drops) and subgroup A2 (treated by latanoprost eye drops). The patients whose IOP was 31-39mmHg, were divided randomly into two subgroups, group B1 (treated by both levobunolol hydrochloride and brimonidine tartrate eye drops) and subgroup B2 (treated by latanoprost and timolol maleate eye drops). The effectiveness and IOP reduction were compared after using eye drops for 3 days and 9 days.
Results
SOG occurred in 84 eyes. After using the eye drops for 3 days, IOP reduction was 3.95±2.57mmHg (15.62%) for 22 eyes in group A1, 6.33±3.12mmHg (24.84%) for 21 eyes in group A2, 8.28 ± 3.56 mmHg (24.58%) for 21 eyes in group B1 and 11.15 ± 4.23 mmHg (32.74%) for 20 eyes in group B2 respectively. The difference was statistically significant within group A (t =2.74, P =0.01) and group B (t =2.42, P =0.02). The number of effective cases of the four groups was 11 eyes (50%) for group A1, 15 eyes (71.43%) for group A2, 8 eyes (38.10%) for group B1 and 12 eyes (60.00%) for group B2 respectively, and the difference was not statistically significant within group A (χ2 =2.06, P =0.22) and group B (χ2 =1.97, P =0.16). After using the eye drops for 9 days, The IOP reduction was 4.18±3.25mmHg (16.19%) and 7.17±3.40mmHg (28.30%) for groups A, and 9.71±3.92mmHg (28.78%) and 13.28±3.47mmHg (39.12%) for groups B respectively. The difference was statistically significant both within group A (t =2.95, P =0.01) and group B (t =3.08, P =0.004). The number of effective cases of the four groups was 10 eyes (45.45%) for group A1, 16 eyes (76.19%) for group A2, 8 eyes (38.10%) for group B1 and 14 eyes (70.0%) for group B2 respectively, and the difference was statistically significant within group A (χ2 =4.25, P = 0.04) and group B(χ2 =4.19, P =0.04).
Conclusions
Alone or in combination, prostaglandin derivatives eye drops can be more effective for the treatment of SOG.
Key words:
Silicone oil; Secondary glaucoma; Prostaglandin derivatives eye drops
Bimatoprost
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To identify changes in intraocular pressure (IOP) after vitreoretinal surgical procedures in eyes that received either difluprednate ophthalmic emulsion 0.05% (DP) or prednisolone acetate ophthalmic suspension 1% (PA).A retrospective chart review compared a consecutive series of 100 patients who received DP with 100 patients who received PA after vitreoretinal surgery. Data were collected for a 3-month period from the time of surgery.A significantly higher number of patients treated with DP (35%, n = 35) developed increased IOP (>21 mmHg with a change from baseline of >10 mmHg) compared with those receiving PA (22%, n = 22) (P = 0.042). The mean maximum IOP in the DP cohort (26.7 mmHg) was significantly higher than that in the PA cohort (22.8 mmHg) (P = 0.0027). Additionally, the rise in IOP from baseline was significantly higher in the DP-treated cohort (9.0 mmHg) than that in the PA-treated cohort (6.0 mmHg) (P = 0.027).Eyes treated with DP after vitreoretinal surgery were at increased risk for developing clinically significant increases in IOP compared with those receiving PA.
Prednisolone
Vitreoretinal Surgery
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