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Objective The purpose of this study was to determine the effects and potential side effects of topical preservative-free (PF) tafluprost 0.0015% in ophthalmologically normal horses. Animals Five adult grade horses. Procedures One of the eyes of each horse was randomly chosen as the "treatment" eye, and consequently, the contralateral eye served as the "control." A single dose of PF tafluprost 0.0015% (0.2 mL) was instilled in the treated eye of each horse. Intraocular pressure (IOP), Schirmer's tear test (STT) levels of each eye, and an ophthalmic examination were performed at T0 (baseline), T30, T120, T24 h, and T48 h. Results The mean IOP values of the treated eyes at baseline (T0), T30, T120, T24 h, and T48 h were 25.4 ± 4.8 mmHg, 21.2 ± 1.92 mmHg, 15.20 ± 2.48 mmHg, 18.40 ± 1.51 mmHg, and 24.60 ± 1.94 mmHg, respectively. Significant differences were observed between the mean baseline IOP level and the T120 and T24 h time points (p = .001 and p = .009). The mean STT levels at each time point showed insignificant fluctuations during the study (p = .140). Adverse effects such as chemosis and episcleral injection were observed 30 min after the instillation of tafluprost 0.0015% (T30). Blepharospasm and conjunctival hyperemia were observed 120 min (T120) after the administration of the medication. Conclusion and clinical relevance Tafluprost 0.0015% showed potential in reducing IOP, but due to its local side effects, it is not a good candidate for management of glaucoma in horses. Tafluprost did not notably affect STT.

BACKGROUND Treatment options for severe ocular von Hippel-Lindau (VHL) disease are limited. This trial evaluated preliminary safety and potential efficacy of combination intravitreous injection with ranibizumab, a vascular endothelial growth factor (VEGF) inhibitor, and E10030, a PDGF inhibitor, for eyes with VHL disease-associated retinal hemangioblastoma (RH) not amenable or responsive to thermal laser photocoagulation. METHODS This was a prospective, single-arm, open-label phase 1/2 study, comprised of three adults with VHL-associated RH and vision loss. Intravitreous injections of ranibizumab (0.5 mg) and E10030 (1.5 mg) were given unilaterally every 4 weeks in the study eye through 16 weeks, then every 8 weeks through 48 weeks. Supplementary standard care therapies were allowed without restriction after 40 weeks. The primary outcome was the ocular and systemic adverse effect profile at 52 weeks. Secondary outcomes included changes in best-corrected visual acuity (BCVA), RH size, exudation, epiretinal proliferation and retinal traction, and need for ablative treatment of RH or ocular surgery at week 52. RESULTS Three participants each received nine injections prior to week 52 and were followed for 104 weeks. One participant manifested mild episodic ocular hypertension in the study eye. Change in BCVA in the study eye at week 52 for the three participants was -5, -12 and +2 letters. No reduction in RH size was measured at 52 weeks. Variable mild improvements in exudation in two participants at week 16 were not sustained through week 52. CONCLUSIONS Combination intravitreous injection with ranibizumab and E10030 demonstrated a reasonable preliminary safety profile, but limited treatment effect.

Background and purpose Glaucoma, the leading cause of blindness, damages the retinal ganglion cells (RGCs). Elevated intraocular pressure (IOP) is a high-risk factor for glaucoma, so topical hypotensive drugs are usually used for treatment. However, not all patients adequately respond to current treatments, so there is a need to identify a new molecular target to reduce IOP. This study was aimed to determine whether the P2Y1 receptors reduce IOP. Experimental approach P2Y1 receptor agonist was instilled on the eyes of mice, and the IOP changes were measured by a rebound-type tonometer. Expression of P2Y1 receptors was estimated by immunohistochemistry. The ocular function was measured by a multifocal electroretinogram. Key results Single-dose of the P2Y1 receptor agonist transiently reduced IOP. The hypotensive effect was disappeared in P2Y1 receptor-deficient (P2Y1 KO) mice. The P2Y1 receptor was functionally expressed in the ciliary body, trabecular meshwork, and Schlemm's canal. We found that P2Y1 receptor negatively regulated aquaporin 4 (AQP4) whereas positively regulated endothelial nitric oxide synthase (eNOS). P2Y1 KO mice showed chronic ocular hypertension regardless of their ages. The P2Y1 KO mice at 3 months old showed no RGC damage, whereas 12-month-old mice showed a significant loss of RGCs and impairment of ocular functions. The RGC damages were attenuated by chronic administration of an IOP-reducing agent. Conclusions and implications P2Y1 receptor activation reduces IOP via dual pathways including AQP4 and eNOS. Dysregulated P2Y1 receptors results in glaucomatous optic neuropathy, suggesting that P2Y1 receptor might be an attractive target for the treatment of glaucoma.

Polyglutamine repeat expansions in the Ataxin-2 (ATXN2) gene were first implicated in Spinocerebellar Ataxia Type 2, a disease associated with degeneration of motor neurons and Purkinje cells. Recent studies linked single nucleotide polymorphisms in the gene to elevated intraocular pressure in primary open angle glaucoma (POAG); yet, the localization of ATXN2 across glaucoma-relevant tissues of the vertebrate eye has not been thoroughly examined. This study characterizes ATXN2 expression in the mouse and human retina, and anterior eye, using an antibody validated in ATXN2(−/−) retinas. ATXN2-ir was localized to cytosolic sub compartments in retinal ganglion cell (RGC) somata and proximal dendrites in addition to GABAergic, glycinergic, and cholinergic amacrine cells in the inner plexiform layer (IPL) and displaced amacrine cells. Human, but not mouse retinas showed modest immunolabeling of bipolar cells. ATXN2 immunofluorescence was prominent in the trabecular meshwork and pigmented and nonpigmented cells of the ciliary body, with analyses of primary human trabecular meshwork cells confirming the finding. The expression of ATXN2 in key POAG-relevant ocular tissues supports the potential role in autophagy and stress granule formation in response to ocular hypertension.

AIMS We aimed to investigate the association between hormonal contraceptive (HC) use and the incidence of glaucoma in females of reproductive age with a focus on duration and type of HCs used. METHODS A retrospective cohort study with a case-control analysis (nested case-control) was undertaken using data from IQVIA's electronic medical record (IQVIA, USA) from 2008 to 2018. Within a cohort of 4 871 504 women, cases of glaucoma or ocular hypertension were identified. Subjects were followed to the first diagnosis of glaucoma. Each glaucoma case was matched to four controls by age, body mass index and follow up time. The main outcome measure was the first diagnosis of glaucoma defined by the first ICD-9/10 code for glaucoma or ocular hypertension. RESULTS Among 4 871 504 women identified, there were 2366 cases of glaucoma and 9464 controls. Regular users of hormonal contraceptives had an elevated risk of glaucoma compared to non-users with an adjusted incident rate ratio (aIRR) of 1.57 (95% CI: 1.29-1.92). Current users were of greatest risk (aIRR of 2.38, 95% CI: 1.81-3.13), whereas the aIRR among past users was 1.08 (95% CI: 0.82-1.43). The aIRR for glaucoma increased from 0.82 (95% CI: 0.70-0.95) among those with one or two prescriptions in the 2 years prior to the first diagnosis of glaucoma to 1.54 (95% CI: 1.32-1.81) among those with greater than four prescriptions. CONCLUSIONS This nested case-control study demonstrated an elevated risk, albeit low, of glaucoma in females of reproductive age who use regular hormonal contraception. Future studies are needed to confirm these findings.

Preservative-free topical medications have been introduced for glaucoma care to reduce ocular adverse events associated with preservatives. This is a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing the efficacy and safety of beta-blockers, or combination using beta-blockers, with and without preservatives. PubMed, EMBASE and Web of Science were examined. Risk of bias was assessed using the Cochrane Handbook for Systematic Reviews. The primary outcome was change in intraocular pressure (IOP) from baseline to final follow-up. Secondary outcomes included ocular and systemic side effects, and other clinical and quality of life outcomes. Of 242 records identified, seven RCTs (1125 patients) were included. The follow-up period ranged from one to 12 months. Timolol was used in five studies, and two studies used a combination (timolol with bimatoprost or dorzolamide). The difference in mean change (MD) in IOP between the preservative-free and the preserved drugs was statistically significant but not clinically relevant: (MD 0.29 mmHg, 95% confidence interval 0.07-0.51 mmHg, p = 0.010; moderate-certainty evidence). Regarding adverse events: Level of evidence for all ocular surface outcome was low or very low and reported in few studies. No significant difference was observed on ocular surface symptoms. Tear break-up time (TBUT) was better with preservative-free drops (p < 0.001). Schirmer's test was better in the preservative-free group (p < 0.001). Level of evidence for all ocular surface outcomes was low or very low. There was no difference in other secondary outcomes. We found no clinically relevant difference in mean change in IOP between the preserved and the preservative-free treatments. Data on adverse events used different methods and were incompletely reported. Although some measures of ocular surface health favoured preservative-free medications, more evidence is needed. The increasing use of preservative-free drops may be associated with better ocular surface and tolerability, but strong evidence from RCTs would be welcome.

OBJECTIVE The aim of the study was to evaluate safety and efficacy of topically administered 0.02% netarsudil-0.005% latanoprost fixed-dose combination (FDC) (Rocklatan™; Aerie Pharmaceutical) in normal and glaucomatous dogs with ADAMTS10-open-angle glaucoma (ADAMTS10-OAG). ANIMALS STUDIED Five normal and five glaucomatous beagle dogs with ADAMTS10-OAG were the study animals. PROCEDURES In each dog, left (OS) or right eye (OD) was randomly selected for netarsudil-latanoprost FDC treatment. Contralateral eyes served as latanoprost-treated controls. The study was divided into four consecutive study periods: following a 4-day baseline period, two sequential 8-day study periods followed with once daily (q24h) and twice daily (q12h) treatments and ending with a washout period. Efficacy was measured by diurnal intraocular pressure (IOP) and pupil diameter. Safety was assessed by routine ophthalmic examination, gonioscopy, and pachymetry. Differences in least square means of quantitative outcome measures were compared between FDC and latanoprost treatments by using the linear Gaussian model. RESULTS Baseline IOPs were 13.6 ± 0.7 mmHg (mean ± SEM) in normal and 28.3 ± 1.4 mmHg in OAG-affected dogs. There was a significant decrease in mean diurnal IOP following FDC administration in both normal (q24h: -2.1 mmHg; q12h: -4.1 mmHg) and glaucomatous dogs (q24h: -14.2 mmHg; q12h: -17.7 mmHg; p

BACKGROUND: Open-angle glaucoma (OAG) is an important cause of blindness worldwide. Laser trabeculoplasty, a treatment modality, still does not have a clear position in the treatment sequence. OBJECTIVES: To assess the effects of laser trabeculoplasty for treating OAG and ocular hypertension (OHT) when compared to medication, glaucoma surgery or no intervention. We also wished to compare the effectiveness of different laser trabeculoplasty technologies for treating OAG and OHT. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2021, Issue 10); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; LILACS, ClinicalTrials.gov and the WHO ICTRP. The date of the search was 28 October 2021. We also contacted researchers in the field. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing laser trabeculoplasty with no intervention, with medical treatment, or with surgery in people with OAG or OHT. We also included trials comparing different types of laser trabeculoplasty technologies. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. Two authors screened search results and extracted data independently. We considered the following outcomes at 24 months: failure to control intraocular pressure (IOP), failure to stabilise visual field progression, failure to stabilise optic neuropathy progression, adverse effects, quality of life, and costs. We graded the 'certainty' of the evidence using GRADE. MAIN RESULTS: We included 40 studies (5613 eyes of 4028 people) in this review. The majority of the studies were conducted in Europe and in the USA. Most of the studies were at risk of performance and/or detection bias as they were unmasked. None of the studies were judged as having low risk of bias for all domains. We did not identify any studies of laser trabeculoplasty alone versus no intervention. Laser trabeculoplasty versus medication Fourteen studies compared laser trabeculoplasty with medication in either people with primary OAG (7 studies) or primary or secondary OAG (7 studies); five of the 14 studies also included participants with OHT. Six studies used argon laser trabeculoplasty and eight studies used selective laser trabeculoplasty. There was considerable clinical and methodological diversity in these studies leading to statistical heterogeneity in results for the primary outcome "failure to control IOP" at 24 months. Risk ratios (RRs) ranged from 0.43 in favour of laser trabeculoplasty to 1.87 in favour of medication (5 studies, I2 = 89%). Studies of argon laser compared with medication were more likely to show a beneficial effect compared with studies of selective laser (test for interaction P = 0.0001) but the argon laser studies were older and the medication comparator group in those studies may have been less effective. We considered this to be low-certainty evidence because the trials were at risk of bias (they were not masked) and there was unexplained heterogeneity. There was evidence from two studies (624 eyes) that argon laser treatment was associated with less failure to stabilise visual field progression compared with medication (7% versus 11%, RR 0.70, 95% CI 0.42 to 1.16) at 24 months and one further large recent study of selective laser also reported a reduced risk of failure at 48 months (17% versus 26%) RR 0.65, 95% CI 0.52 to 0.81, 1178 eyes). We judged this outcome as moderate-certainty evidence, downgrading for risk of bias. There was only very low-certainty evidence on optic neuropathy progression. Adverse effects were more commonly seen in the laser trabeculoplasty group including peripheral anterior synechiae (PAS) associated with argon laser (32% versus 26%, RR 11.74, 95% CI 5.94 to 23.22; 624 eyes; 2 RCTs; low-certainty evidence); 5% of participants treated with laser in three studies of selective laser group had early IOP spikes (moderate-certainty evidence). One UK-based study provided moderate-certainty evidence that laser trabeculoplasty was more cost-effective. Laser trabeculoplasty versus trabeculectomy Three studies compared laser trabeculoplasty with trabeculectomy. All three studies enrolled participants with OAG (primary or secondary) and used argon laser. People receiving laser trabeculoplasty may have a higher risk of uncontrolled IOP at 24 months compared with people receiving trabeculectomy (16% versus 8%, RR 2.12, 95% CI 1.44 to 3.11; 901 eyes; 2 RCTs). We judged this to be low-certainty evidence because of risk of bias (trials were not masked) and there was inconsistency between the two trials (I2 = 68%). There was limited evidence on visual field progression suggesting a higher risk of failure with laser trabeculoplasty. There was no information on optic neuropathy progression, quality of life or costs. PAS formation and IOP spikes were not reported but in one study trabeculectomy was associated with an increased risk of cataract (RR 1.78, 95% CI 1.46 to 2.16) (very low-certainty evidence). AUTHORS' CONCLUSIONS: Laser trabeculoplasty may work better than topical medication in slowing down the progression of open-angle glaucoma (rate of visual field loss) and may be similar to modern eye drops in controlling eye pressure at a lower cost. It is not associated with serious unwanted effects, particularly for the newer types of trabeculoplasty, such as selective laser trabeculoplasty.

International audience; urposeTo evaluate the efficacy of preventive treatment against allograft rejection after endothelial keratoplasty (EK), we conducted a systematic review and meta-analysis.MethodPubMed, Cochrane Library, Embase and ScienceDirect databases were searched until May 2021. We computed a random-effect meta-analysis on graft rejection rate stratified by the intervention (i.e. Descemet membrane EK (DMEK) and Descemet stripping (Automated) EK (DS(A)EK) or ultrathin (UT)-DSAEK), and postoperative treatment. Meta-regressions were performed to compare intervention, treatment and influence of putative confusion factors.ResultsWe included 49 studies and 12 893 EK (6867 DMEK and 6026 DS(A)EK/UT-DSAEK). Topical steroids were merged in two efficacy regimens: standard steroids (prednisolone acetate 1% or dexamethasone 0.1%) and soft steroids (fluorometholone 0.1% or loteprednol etabonate 0.5%). Globally, DMEK had a lower graft rejection rate than DS(A)EK/UT-DSAEK (coefficient − 3.3, 95 CI, −4.60 to −1.90; p

Objective Determine the immediate post-operative effects of MicroPulse™ transscleral cyclophotocoagulation (MP-TSCPC) in healthy equine eyes. Animals studied Ten adult horses. Methods MP-TSCPC was performed on sedated horses in 12 eyes (4 groups) using the following parameters (power, duration, duty cycle): (1) 2000 mW, 180 seconds, 31.3%; (2) 3000 mW, 180 seconds, 31.3%; (3) 3000 mW, 270 seconds, 31.3%; and (4) 3000 mW, 270 seconds, 50%. Three additional eyes were left untreated (control). Eyes were monitored clinically until euthanasia (mean = 3 hours post-procedure). Histologic sections were assessed with light microscopy and transmission electron microscopy (TEM). Results MP-TSCPC was well tolerated by sedated horses. Adverse effects were only noted in Group 4: ocular hypertension (n = 3/3), conjunctival burns (3/3), aqueous flare (2/3), and a corneal erosion (1/3). Histologic scoring of Group 4 was statistically greater than other treated groups (1-3) and control eyes (P ≤ .021). TEM showed subtle changes to the mitochondria and plasma membrane infoldings of the basilar surface of the nonpigmented epithelium in all treated eyes. Conclusions MP-TSCPC does not cause immediate post-procedure adverse clinical effects or pronounced morphological changes to the ciliary body, except with the highest laser settings evaluated (power 3000 mW, duration 270 seconds, duty cycle 50%).

Purpose To investigate the relationship between gonioscopic iridocorneal angle (ICA) morphology and the incidence of postoperative ocular hypertension (POH) and postoperative glaucoma in dogs undergoing cataract surgery. Animals studied Retrospective analysis of 138 eyes of 78 canine patients who underwent phacoemulsification at North Carolina State University from December 1, 2015 through April 30, 2017. Methods Medical records of all phacoemulsification patients with preoperative RetCam gonioscopic images were reviewed for preoperative, intraoperative, and postoperative variables. Gonioscopic angle indices were calculated using a novel (ZibWest) angle grading system, and these indices were analyzed for outcome-related significance. Results Increased surgeon experience was associated with increased probability of POH and vision loss. Higher average ZibWest Angle indices (ie, more open angles with less pectinate ligament dysplasia/ abnormality) were associated with a significantly decreased probability of medically unresponsive glaucoma. Increased patient age was significantly associated with an increased probability of both postoperative glaucoma and vision loss. Female dogs were significantly more likely to experience postoperative glaucoma compared to male dogs. Increased surgery time was significantly associated with increased probability of vision loss. Conclusions The ZibWest angle index may predict increased risk for developing medically unresponsive glaucoma with cataract surgery. Female sex, and increased patient age, surgical time, and surgeon experience were associated with increased postoperative morbidity.

Lysyl oxidase like-1 (LOXL1), a vital crosslinking enzyme in elastin fiber maintenance, is essential for the stability and strength of elastic vessels and tissues. Variants in the LOXL1 locus associate with a dramatic increase in risk of exfoliation syndrome, a systemic fibrillopathy, which often presents with ocular hypertension and exfoliation glaucoma. We examined the role of LOXL1 in conventional outflow function, the prime regulator of intraocular pressure. Using Loxl1(−/−), Loxl1(+/−) and Loxl1(+/+) mice, we observed an inverse relationship between LOXL1 expression and intraocular pressure, which worsened with age. Elevated intraocular pressure in Loxl1(−/−) mice was associated with a larger globe, decreased ocular compliance, increased outflow facility, extracellular matrix abnormalities, and dilated intrascleral veins, yet no dilation of arteries or capillaries. Interestingly, in living Loxl1(−/−) mouse eyes, Schlemm’s canal was less susceptible to collapse when challenged with acute elevations in intraocular pressure, suggesting elevated episcleral venous pressure. Thus, LOXL1 expression is required for normal intraocular pressure control, while ablation results in altered extracellular matrix repair/homeostasis and conventional outflow physiology. Dilation of Schlemm’s canal and distal veins, but not arteries, is consistent with key structural and functional roles for elastin in low-pressure vessels subjected to cyclical mechanical stress.

Purpose As part of our investigations of intraocular pressure (IOP) as a potential contributing factor to the spaceflight‐associated neuro‐ocular syndrome using the 6° head‐down tilt (6°HDT) bed rest experimental model, we compared the effect of rest and isometric exercise in prone and supine 6°HDT positions on IOP with that observed in the seated position. Methods Ten male volunteers (age = 22.5 ± 3.1 yrs) participated in six interventions. All trials comprised a 10‐min rest period, a 3‐min isometric handgrip exercise at 30% of participant's maximum, and a 10‐min recovery period. The trials were conducted under normocapnic (NCAP) or hypercapnic (FICO2 = 0.01; HCAP) conditions, the latter mimicking the ambient conditions on the International Space Station. IOP, systolic and diastolic pressures, and heart rate (HR) were measured during the trials. Results Isometric exercise‐induced elevations in HR and mean arterial blood pressure. IOP in the prone 6°HDT position was significantly higher (p, Intraocular pressure(IOP) in the prone 6 head‐down tilt (HDT) position was similar to IOP reported in astronauts upon entering microgravity, potentially indicating that prone, rather than supine 6°HDT position might be a more suitable experimental analog for investigating the acute ocular changes that occur in microgravity.

Purpose To assess outcome of phacoemulsification in cats. Methods Records of 71 cats (82 eyes) from five referral centers were reviewed. Groups were divided by cause of cataract (congenital/juvenile [n = 32], traumatic [n = 33], and secondary to uveitis [n = 6]), and group comparisons were performed for the most common complications: postoperative ocular hypertension (POH), uveitis, corneal ulceration, synechia/dyscoria, and posterior capsular opacity (PCO) in three different time periods: immediately postoperatively, at 1‐90 days, and at >90 days. Results Median follow‐up was 198 days (interquartile range 64‐518 days). The overall visual success rate of the cats with a 12‐month follow‐up was 92.6% (25/27 eyes). POH occurred in 35/82 (42.6%) eyes. Immediately postoperatively, uveitis was the most common complication in 28/82 eyes (34.1%) followed by corneal ulceration in 22/82 eyes (26.8%). At 1‐90 days, uveitis in 41/81 eyes (50.6%) remained the most common complication, followed by synechia/dyscoria in 21/81 eyes (25.9%), corneal ulceration in 16/81 eyes (19.7%), and PCO in 15/81 eyes (18.5%). At >90 days, PCO in 17/47 eyes (36.1%), followed by synechia/dyscoria in 16/47 eyes (34%), was the most common complications. The number of eyes with synechia/dyscoria in the trauma group was higher (13/33 [39.3%]) than in the congenital/juvenile group (5/31 [16.1%]) at 1‐90 days (P = .039). No statistical difference was found for the other group comparisons. Three eyes in total were enucleated owing to endophthalmitis, post‐traumatic ocular sarcoma, and secondary glaucoma. Conclusion Uveitis in the short‐term and PCO and synechia/dyscoria in the long‐term were the most common complications following phacoemulsification in cats.

Objective To describe and assess the clinical outcome and intraoperative and postoperative complications of Descemet's stripping endothelial keratoplasty (DSEK) in the treatment of canine corneal endothelial dystrophy. Animals studied Six dogs (six eyes) diagnosed with progressive corneal edema resulting from abnormal dystrophic endothelial cells underwent Descemet's stripping endothelial keratoplasty. Procedures Six patients underwent Descemet's stripping endothelial keratoplasty (DSEK). The patients were examined preoperatively and postoperatively at 24 hours, 7 days, 1, 2, and 3 months after surgery. Corneal edema and ultrasonic pachymetry were evaluated preoperatively and postoperatively. The positions of DSEK grafts were evaluated 3 months after surgery using optical coherence tomography. Intraoperative and postoperative complications were noted. Results The degree of corneal edema and corneal thickness improved postoperatively in all the patients (n = 6). Fibrin was encountered intraoperatively in one out of the six eyes (1/6) and postoperatively in two out of the six eyes (2/6). One out of the six DSEK grafts was partially scrolled (1/6). Secondary ocular hypertension was observed in one out of the six eyes (1/6). Corneal vascularization was encountered in four out of six patients (4/6). Conclusions Descemet's stripping endothelial keratoplasty is an effective surgical treatment option for corneal endothelial dystrophy in dogs. Corneal edema resolved and corneal thickness reduced significantly. The early postoperative results are encouraging. Further investigation is warranted to document any long-term complications and to study the longevity of the transplanted grafts.

Objective To evaluate the postoperative effect of intracameral tPA (alteplase; Activase®, Genentech, San Francisco, CA), administered at immediate conclusion of phacoemulsification, on anterior chamber fibrin formation in dogs. Procedures Forty-one dogs (82 eyes) undergoing bilateral phacoemulsification received 25 μg/0.1 mL intracameral tPA in one eye and 0.1 mL unmedicated aqueous vehicle in the contralateral eye immediately after corneal incision closure. Intraocular pressure (IOP) was measured, and severity of anterior chamber fibrin formation, aqueous flare, pigment precipitates on the intraocular lens (IOL) implant, posterior capsular opacification (PCO), and corneal edema were graded at approximately 1 week, 2-3 weeks, 4-6 weeks, 8-12 weeks, and greater than 3 months postoperatively. Results Anterior chamber fibrin developed postoperatively in 68.3% of dogs (28/41) and 50% of eyes (41/82). In tPA-treated eyes, 53.7% (22/41) developed fibrin compared to 46.3% of control eyes (19/41). Some degree of postoperative ocular hypertension (POH) occurred in 53.7% of dogs (22/41) and 36.5% of eyes (30/82). In tPA-treated eyes, 34.1% (14/41) experienced POH compared to 39% of control eyes (16/41). Additional intracameral tPA injection was later required in 29.3% of both tPA-treated (12/41) and control eyes (12/41). Conclusions Administration of intracameral tPA at immediate conclusion of canine phacoemulsification had no clinically observable effect on anterior chamber fibrin incidence at any time point. tPA-treated eyes showed no prophylaxis against POH or secondary glaucoma compared to control eyes and received late postoperative tPA injections at the same frequency as control eyes.

Microglia activation and release of pro-inflammatory cytokines have been closely linked to glaucoma. However, the mechanisms that initiate these pathways remain unclear. Here, we investigated the role of a pro-inflammatory cytokine--osteopontin (OPN), in retinal microglia activation process along with the underlying mechanisms in glaucoma. A rat chronic ocular hypertension (COH) model was established presenting an increase in retinal OPN level and activation of microglia. Primary microglia cells were isolated and cultured under a pressure culture system showing heightened expressions of microglia-derived OPN with changes in inflammatory factors (TNF-α, IL-1β, and IL-6). OPN and OPN neutralizing antibody (Anti-OPN) interventions were both applied systems for comparison, and cross-referenced with OPN knockdown in vitro. JAK/STAT, NF-κB, ERK1/2, and p38 MAPK, recognized as the primary signaling pathways related to microglia activation, were then screened on whether they can facilitate OPN to act on microglia and their impact on specific inhibitors. Thereafter, retrograde labeling of retinal ganglion cells (RGCs) and flash visual evoked potentials (F-VEP) were used to investigate neuron protection in context of each blockade. Results suggest that OPN is able to enhance the proliferation and activation of retinal microglia in experimental glaucoma which may play a role in the glaucomatous optic neuropathy, and contribute to the eventual RGCs loss and vision function impairment. Such effect may be mediated through the regulation of p38 MAPK signaling pathway.

Producción Científica, Silicone oil (SO) still represents the main choice for long-term intraocular tamponade in complicated vitreoretinal surgery. This review compared the complications associated with the use of SO and other vitreous substitutes after pars plana vitrectomy in patients with different underlying diseases. Meta-analysis was conducted in accordance with PRISMA guidelines. We retrieved randomized clinical trials (RCTs), retrospective case–control and cohort studies evaluating the risk of using SO, published between 1994 and 2020, conducting a computer-based search of the following databases: PubMed, Web of Science, Scopus and Embase. Primary outcome was the rate of complications such as intraocular hypertension, retinal re-detachment, unexpected vision loss or hypotony. Secondary outcome was to compare the rate of adverse events of different SO viscosities, especially emulsification. Forty-three articles were included. There were significant differences in intraocular hypertension (p = 0.0002, OR = 1.66; 95% CI = 1.27–2.18) and the rate of retinal re-detachment (p

PURPOSE To compare the long-term safety and efficacy of pattern scanning laser trabeculoplasty (PSLT) and selective laser trabeculoplasty (SLT). METHODS This was a retrospective database analysis (Lausanne Laser Trabeculoplasty Registry) of patients having had laser trabeculoplasty (LT) prior to 2017 with a minimum follow-up of 1 year. Inclusion criteria were age ≥40 years and diagnosis of ocular hypertension (OHT) and open-angle glaucoma (OAG). Selective laser trabeculoplasty (SLT) eyes were matched to PSLT eyes according to baseline intraocular pressure (IOP), baseline number of ocular hypotensive medications (OHM) and glaucoma diagnosis. Success was defined as an IOP ≤ 20% from baseline or an IOP equal or lower than baseline accompanied by a reduction in OHM. Multivariate regression models were used to study associations between success and baseline clinical parameters. RESULTS From 280 eyes in the database, 81 eyes had PSLT and were matched with 81 SLT eyes (162 patients). Mean age was 69.4 ± 12.1 years, and 56.2% were female. Mean IOP was 18.6 ± 5.3 and 18.2 ± 4.1 mmHg at baseline and 15.9 ± 3.0 and 16.0 ± 3.4 mmHg at 12 months and 15.2 ± 2.7 and 16.2 ± 3.4 mmHg at 24 months, for PSLT and SLT, respectively. 60.5% of PSLT and 65.4% of SLT eyes achieved treatment success (p = 0.20). Number of OHM was 1.0 ± 1.0 and 1.4 ± 1.2, respectively (p = 0.052). Baseline IOP (OR = 1.23, p

PURPOSE Garcinia kola (bitter kola) is locally ingested across the West African subregion. It has ocular hypotensive effects similar to some commonly used glaucoma medications when administered topically. The study assessed the effect of oral ingestion of G. kola on intraocular pressure (IOP). METHOD A randomized, single-blind, placebo-controlled, cross-over design was used in this study. Forty-six healthy subjects, aged between 19 and 27 years were recruited and randomized into two groups (A and B). Subjects in group A ingested 100 mg/kg body weight bitter kola in a 200 ml solution on their first visit and group B ingested 200 ml of water. On the second visit, the order of treatment was reversed, IOP was measured at baseline and every 45 min interval for 135 min. The mean difference between the baseline and post-treatment IOP measurements were tested for statistical significance using repeated-measures analysis of variance (95% confidence intervals [CIs]). RESULTS Mean IOP measurements decreased by 7.9, 18.2 and 20.6% at 45, 90 and 135 min, respectively, after G. kola treatment. The reduction, though variable across subjects, was statistically significant (F [2.13, 95.62] = 90.35, p

OBJECTIVE: To describe the clinical application and effect of MicroPulse™ transscleral cyclophotocoagulation (MP‐TSCPC) in dogs with glaucoma. ANIMALS STUDIED: Twelve dogs with primary (n = 8) or secondary (n = 4) glaucoma, aged 2‐13 years (mean ± SD, 7.2 ± 3.8 years). PROCEDURES: MP‐TSCPC was performed under sedation or general anesthesia. Laser duty cycle was 31.3%, laser power varied from 2000‐2800 mW, and each hemisphere was treated for 90‐180 seconds. The probe was applied to each quadrant in a “sweeping motion,” sparing the 3 and 9 o'clock positions. RESULTS: The number of MP‐TSCPC procedures per eye varied from 1 to 3 (1.4 ± 0.7). Intraocular pressure (IOP) was controlled (

Importance Glaucoma treatment has often been associated with adverse side‐effects from preservatives that are included in the used eye drops. Background To evaluate changes in the ocular surface and the presence of prostaglandin‐induced corneal disorders after being switched from latanoprost 0.005% to low preservative tafluprost 0.0015% ophthalmic solution. Design Single centre, prospective study. Participants Patients with primary open‐angle glaucoma or ocular hypertension that had received treatment with once daily latanoprost 0.005% ophthalmic solution for control of intraocular pressure (IOP) for 3 months, with a score of above 1 on the National Eye Institute (NEI) ocular surface staining scale. Methods Following the ≥3 month latanoprost treatment period, patients were switched to once daily low preservative tafluprost 0.0015% ophthalmic solution. Patients were followed for a minimum of 3 months. Main Outcome Measures Ocular surface changes were assessed by fluorescein staining score (NEI scale). Additional evaluations included tear break‐up time, hyperaemia score, subjective symptoms, changes in intraocular pressure and presence of adverse reactions. Results Out of 59 patients enrolled, 51 were included in the final analysis. Fluorescein staining scores at baseline, prior to treatment switch, were 6.9 ± 3.1 and 3.3 ± 2.7 at the end of the study period (change in scores was −3.6 ± 2.2 [P < 0.001]). At last follow‐up, significant improvements were observed in tear break‐up time, hyperaemia score and subjective symptoms (all P < 0.05). Conclusions and Relevance The clinical signs of ocular surface disease and subjective symptoms of dry eyes improved following the switch to low preservative tafluprost and demonstrated comparable IOP lowering effectiveness.

Purpose To characterize the two-dimensional parameter Bruch's membrane opening minimum rim area (BMO-MRA) in spectral domain optical coherence tomography (SD-OCT) of the optic nerve head (ONH) compared to minimum rim width (BMO-MRW) and retinal nerve fibre layer (RNFL) thickness in a large patient cohort. Methods Case-control, cross-sectional study of 705 eyes of 445 participants. A total of 449 eyes with glaucoma, 67 eyes with ocular hypertension and 189 healthy controls, underwent SD-OCT and confocal laser scanning tomography (CSLT), visual field testing and clinical examination. Morphometric ONH parameters, visual field function and diagnostic power were compared. Main outcome measures were SD-OCT-derived BMO-MRA, BMO-MRW, RNFL thickness and CSLT-derived rim area (DM-RA). Results Mean ONH area was 2.11 +/- 0.57 mm(2); mean BMO area was 1.89 +/- 0.45 mm(2). Correlation of mean deviation in visual field to morphometric parameters was rho = 0.70, (p 0.05), while DM-RA correlated significantly worse (rho = 0.55; p < 0.001). In receiver operating characteristics, the calculated area under the curve (AUC) and sensitivity at 90% specificity to differentiate glaucoma were 0.87% and 70.1% for BMO-MRA, 0.86% and 68.1% for RNFL thickness, 0.84% and 66.0% for BMO-MRW, 0.82% and 51.3% for DM-RA. Conclusions In a heterogenous clinical cohort of glaucoma patients, all analysed SD-OCT parameters excel DM-RA of CSLT. The two-dimensional parameter BMO-MRA shows comparable levels of diagnostic power to detect glaucoma compared to established parameters BMO-MRW and RNFL thickness. Given higher comparability between ONH sizes, BMO-MRA might become an additional standard tool in SD-OCT imaging for glaucoma.

PURPOSE To investigate the effects of bariatric surgery on intraocular pressure (IOP). METHODS We prospectively enroled consecutive obese patients who underwent a laparoscopic sleeve gastrectomy procedure. We measured IOP prior to and 3-6 months following surgery and recorded medical and demographical parameters. RESULTS Thirty-two patients completed all evaluations. Mean age was 40.5 ± 12 and 24 (75%) were men. Following surgery, mean body-mass index (BMI) decreased from 42 ± 6 to 31 ± 8 (p

Glaucoma is an ophthalmic disease that is characterized by elevated intraocular pressure (IOP). Eye drops are the preferred choice to reduce IOP for the treatment of glaucoma. However, the bioavailability of eye drops is low (

Purpose To assess the efficacy and safety of different regimens, including monotherapy and double therapy, for primary open-angle glaucoma (POAG) or ocular hypertension. Methods We searched PubMed, EMBASE and clinicaltrials.gov for studies that fit our inclusion criteria in this network meta-analysis. Randomized controlled trials that report data on efficacy and safety of medications for POAG or ocular hypertension are included. Data on intra-ocular pressure (IOP) lowering effect and incidence of adverse events including hyperaemia and ocular discomfort were extracted and used in mixed-comparison analysis. Results This study includes 72 randomized trials. Data were available on 12 medical treatments of POAG or ocular hypertension. Of 66 possible comparisons of outcome efficacy, 15 treatments were compared directly. Compared to prostaglandin analogues (PGA), beta-blockers (BB) showed relatively weaker ability to lower IOP, followed by α2-adrenergic agonists (AA) and carbonic anhydrase inhibitors (CAI). For dual therapy, regimens composed of a combination of PGA with another treatment demonstrated more powerful IOP lowering efficacy, while the combination of two non-PGA drugs had lower efficacy in controlling IOP than PGA alone. There was no statistical significance in combinations that did not include PGA on efficacy of IOP control. In terms of tolerance, PGA alone leads to more severe hyperaemia than any other monotherapy regimen, while BBs have the lowest effect on the incidence of hyperaemia. Most dual therapy regimens containing PGA also lead to serious hyperaemia, with the exception of PGA + AA. Compared to regimens containing PGA, those with BB are less likely to cause hyperaemia. Conclusion Our network meta-analysis showed that PGAs provide best IOP lowering effect among all the monotherapy regimen. Combination of PGA and other category of drugs leads to better IOP decrease. Combination of BB and another non-PGA drug may have less ocular side-effects than PGA alone.

The underlying pathophysiology of primary open-angle glaucoma remains unclear, but the lamina cribrosa seems to be the primary site of injury, and raised intraocular pressure is a major risk factor. In recent years, a decreased intracranial pressure, leading to an abnormally high trans-lamina cribrosa pressure difference, has gained interest as a new risk factor for glaucoma. New research now lends support to the hypothesis that a paravascular transport system is present in the eye analogous to the recently discovered 'glymphatic system' in the brain, which is a functional waste clearance pathway that promotes elimination of interstitial solutes, including beta-amyloid, from the brain along paravascular channels. Given that beta-amyloid has been reported to increase by chronic elevation of intraocular pressure in glaucomatous animal models and to cause retinal ganglion cell death, the discovery of a paravascular clearance system in the eye may provide powerful new insights into the pathophysiology of primary open-angle glaucoma. In this review, we provide a new conceptual framework for understanding the pathogenesis of primary open-angle glaucoma, present supporting preliminary data from our own post-mortem study and hypothesize that the disease may result from restriction of normal glymphatic flow at the level of the lamina cribrosa owing to a low intracranial pressure and/or a high translamina cribrosa pressure gradient. If confirmed, this viewpoint could offer new perspectives for the development of novel diagnostic and therapeutic strategies for this devastating disorder.

Glaucoma is a leading cause of blindness, characterized by retinal ganglion cell (RGC) loss and optic nerve (ON) damage. Cumulative evidence suggests glial cell involvement in the degeneration of the ON and RGCs. We analyzed the contribution of microglial reactivity to early axoglial alterations of the ON in an induced model of ocular hypertension. For this purpose, vehicle or chondroitin sulfate (CS) were weekly injected into the eye anterior chamber from Wistar rats for different intervals. The amount of Brn3a(+) RGC significantly decreased in CS-injected eyes for 10 and 15 (but not 6) weeks. A reduction in anterograde transport of β-subunit cholera toxin (CTB) was observed in the superior colliculus and the lateral geniculate nucleus contralateral to CS-injected eyes for 6 and 15 weeks. A disruption of CTB transport was observed at the proximal myelinated ON. A significant decrease in phosphorylated neurofilament heavy chain (pNFH)-immunoreactivity, an increase in Iba-1(+), ED1(+) (microglial markers), and glial fibrillary acidic protein (GFAP, astrocytes) (+) area, and decreased luxol fast blue (LFB) staining were observed in the ON at 6 and 15 weeks of ocular hypertension. Microglial reactivity involvement was examined through a daily treatment with minocycline (30 mg/kg, i.p.) for 2 weeks, after 4 weeks of ocular hypertension. Minocycline prevented the increase in Iba-1(+), ED-1(+), and GFAP(+) area, the decrease in pNFH-immunoreactivity and LFB staining, and the deficit in anterograde transport induced by 6 weeks of ocular hypertension. Thus, targeting microglial reactivity might prevent early axoglial alterations in the glaucomatous ON. Fil: Bordone, Melina Paula. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentina Fil: González Fleitas, María Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentina Fil: Pasquini, Laura Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Físico-Química Biológicas "Prof. Alejandro C. Paladini". Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Físico-Química Biológicas; Argentina Fil: Bosco, Alejandra. University of Utah; Estados Unidos Fil: Sande Casal, Pablo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentina Fil: Rosenstein, Ruth Estela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentina Fil: Dorfman, Damián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; Argentina

Purpose To compare the additive effects and safety of 1% brinzolamide/0.5% timolol fixed combination (BTFC) versus the low-dose regimen of 1% dorzolamide/0.5% timolol fixed combination (DTFC) in patients with open-angle glaucoma and ocular hypertension (OAG/OH) following treatment with prostaglandin analogues (PGAs). Methods A prospective, randomized, double-masked, multicentre, parallel-group and active-controlled study included 201 Japanese OAG/OH patients who had been treated with PGA. Efficacy was assessed as the change in intra-ocular pressure (IOP) from baseline after weeks 4 and 8. Safety was assessed with adverse event rates, ocular discomfort score, blur scale, blood pressure and heart rates, best-corrected visual acuity (BCVA) and slit lamp examinations. Results Intra-ocular pressure (IOP) change from baseline at 9 AM/11 AM pooled over the 8 weeks was −3.3/−3.3 mmHg in the BTFC group and −2.9/−3.4 mmHg in the DTFC group, demonstrating non-inferiority of BTFC to DTFC. Ocular irritation was frequently seen in DTFC group. Although blurred vision was frequently seen in BTFC group, it was transient and blurring became the equivalent 3 min after instillation between two groups. No noteworthy issue was observed in other safety outcome. Conclusion Non-inferiority of BTFC to DTFC in IOP reduction was demonstrated after adding onto PGA therapy in Japanese OAG/OH patients. Although the score of blurred vision was transiently higher in BTFC than DTFC, treatment difference decreased and disappeared with time. Thus, BTFC can be considered as a safe and effective agent for glaucoma treatment.

Objective To determine whether topical hypotensive medications prevent postoperative ocular hypertension (POH) after phacoemulsification. Animals studied 52 client-owned dogs (88 eyes). Procedures Diabetic and nondiabetic dogs having undergone phacoemulsification were included in this retrospective study. The control group received no ocular hypotensive medications. The treatment groups received latanoprost, dorzolamide, or dorzolamide/timolol, beginning immediately after surgery, for 2-week duration. IOPs were obtained at initial examination followed by 4 h, 24 h, 7 days, and 14 days postoperatively. POH was defined as an IOP above 20 mmHg (POH20) or 25 mmHg (POH25). Results POH20 occurred in 33 of 87 eyes (37.93%), including 11 of 21 eyes (52.38%) in the control group, three of 23 eyes (13.04%) in the latanoprost group, eight of 15 eyes (53.33%) in the dorzolamide group, and 11 of 28 eyes (39.29%) in the dorzolamide/timolol group. Active treatment groups were compared to the control group, and the overall group effect was not significant (P = 0.11). POH25 occurred in 22 of 86 eyes (25.58%), including seven of 21 eyes (33.33%) in the control group, two of 23 eyes (8.70%) in the latanoprost group, five of 15 eyes (33.33%) in the dorzolamide group, and eight of 27 eyes (29.63%) in the dorzolamide/timolol group. Active treatment groups were compared to the control group, and the overall group effect was not significant (P = 0.31). Intraoperative use of intracameral tissue plasminogen activator significantly decreased the chances of POH25 (P = 0.0063). Conclusions and clinical relevance The latanoprost group had a substantially lower percentage of POH 20 and POH25 compared to the control and other active treatment groups, although statistical significance was not achieved. Intraoperative intracameral tissue plasminogen activator decreased the incidence of POH25.

Due to a growing and ageing population, the number of Australians living with chronic eye conditions such as glaucoma and ocular hypertension is projected to increase.1 The current unmet demand for public hospital ophthalmology appointments have caused waiting periods for routine, non-urgent referrals to often exceed 12 months.2

Purpose To evaluate the apparent intraocular pressure (IOP) change observed after treatment with latanoprost in naive eyes of patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) using Goldmann applanation tonometer (GAT), ocular response analyzer (ORA) and Corvis ST tonometry. Methods Prospective observational cohort study. One eye from each of 59 newly diagnosed patients with POAG or OHT in our institution was analysed. IOP readings obtained using GAT, ORA and Corvis at baseline and after a 3-month period of treatment with latanoprost were compared. Additionally, pre- and post-treatment biomechanical corneal parameters provided by the Corvis tonometer were analysed. Results There was no statistically significant difference between the apparent treatment-induced IOP reductions when GAT and ORA were compared (p > 0.05). In contrast, the treatment-induced IOP reduction recorded using the Corvis tonometer was significantly smaller compared to the apparent IOP reduction observed with GAT and ORA (p = 0.0001 for both comparisons). With respect to biomechanical corneal properties, statistically significant changes were found after 3 months of treatment with latanoprost for the first corneal applanation time (AT1) (p = 0.001), second corneal applanation time (AT2) (p = 0.001) and deformation amplitude (DA) (p = 0.0003). Conclusion Following a 3-month course of latanoprost, the apparent treatment-induced IOP reduction in previously naive patients with POAG or OHT differed depending on the tonometer used. Certain corneal biomechanical parameters assessed using Corvis ST exhibited a significant change. The ocular hypotensive effect of prostaglandin analogues may be overestimated when chronically treated patients are measured using GAT or ORA.

Objectives To establish an intraocular pressure curve protocol that is safe for corneal health and detects harmful elevations of intraocular pressure outside normal clinic hours. To determine inter-user variability and if repeated measurements affect intraocular pressures. Materials and Methods Intraocular pressures were measured in dogs with glaucoma using three protocols: Protocol 1 used applanation tonometry every 2 hours over a 24-hour period; Protocols 2 and 3 used applanation or rebound tonometry, respectively, and measured intraocular pressures every 3 hours over a 30-hour period. A total of 60 additional intraocular pressure curves from dogs with glaucoma and 20 from healthy dogs were then analysed for inter-user variability. Results A total of 128 intraocular pressure curves were determined in 30 dogs. Protocol 1 resulted in one ulcer in five pressure curves, Protocol 2 in one ulcer in 62 pressure curves and Protocol 3 in no ulcers in 61 pressure curves. Elevated intraocular pressures were detected on 61 occasions, of which 26 developed outside normal clinic hours. A total of 61 additional intraocular pressure curves revealed that repeated measurements had no effect on intraocular pressure. Clinical Significance Protocol 3, using rebound tonometry every 3 hours for 30 hours is safe corneal health and identified elevated intraocular pressures outside normal clinic hours in 12 of 30 (40%) patients that single intraocular pressure measurement during consultation hours would not have identified. Intraocular pressure curves may be recommended for clinical practice and glaucoma studies.

Purpose To evaluate the reliability of intraocular pressure measured by patients with glaucoma themselves using a new hand-held tonometer and to observe whether the intraocular pressure (IOP) variations have the same pattern on different days while glaucoma treatment is constant. Methods Eighty-seven patients diagnosed with open-angle glaucoma or ocular hypertension were recruited to the study. Intraocular pressure measured using Goldmann applanation tonometry (GAT) was compared with IOP measured using tonometry at baseline and on the second visit. Patients measured their IOP at home using the hand-held tonometers. Results The mean difference between GAT and iCare® values varies from 0 to 1 mmHg. Seventy-eight per cent of iCare® measurements were within 3 mmHg of the GAT measurements. Approximately 64% of the study eyes had higher IOP in the morning than in the afternoon/evening. Circadian patterns differed between consecutive days in 47% of the study eyes. There were IOP peaks outside office hours in up to 16% of the study eyes. Conclusion Measurements made using rebound self-tonometry are accurate and could be used to complement the investigation of patients with glaucoma. Intraocular pressure curves provide valuable data usable when adapting glaucoma treatment.

Purpose To describe the clinical and histopathologic features of glaucoma associated with Descemet's membrane (DM) detachment in five horses without prior history of intraocular surgery. Animals studied Three Appaloosa horses and two Thoroughbreds were included in this study. The affected horses ranged in age from 16 to 27 years and presented with severe diffuse corneal edema. Procedure Five eyes were enucleated due to intraocular hypertension and/or chronic corneal ulceration. The enucleated globes were evaluated by the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW). Each globe was routinely processed for histopathology and analyzed by light microscopy. A histologic diagnosis of glaucoma was reached by demonstrating a loss of optic nerve axonal tissue by measuring neurofilament-immunopositive axons with automated image analysis software. Results All five horses presented with unilateral severe diffuse corneal edema that had developed between 2 and 16 weeks prior to enucleation. Intraocular pressures for the affected eyes were between 9 and 87 mmHg prior to enucleation. Descemet's membrane detachment was identified histopathologically in all five globes (5/5, 100%). All five eyes had an avascular spindle cell proliferation filling the space between the displaced peripheral DM and the corneal stroma. Neurofilament immunostaining revealed axonal loss consistent with glaucoma. Conclusion Equine glaucoma may be associated with Descemet's membrane detachment. This detachment and glaucoma is a possible differential diagnosis for severe equine corneal edema. In this case series, an eye with a DM detachment had a poor prognosis for retention.

Objective To compare the prevalence and kinetics of ocular hypertension after routine cataract extraction when using a predominately COX-2 inhibitor (bromfenac) versus a predominately COX-1 inhibitor (flurbiprofen) in combination with a topical corticosteroid. Procedures Patients undergoing unilateral or bilateral cataract surgery were randomly assigned to receive flurbiprofen or bromfenac at the day of surgery and continued for 6 weeks postoperatively, along with topical neo poly dexamethasone. No systemic nonsteroidal anti-inflammatory medications were administered before or after surgery. Intraocular pressure was monitored pre and postoperatively. When an IOP of >25 mmHg was detected, therapeutic intervention was performed. Results Eyes in both treatment groups showed a similar IOP profile with the highest mean IOP occurring two hours postsurgery and slowly declining during the next 6 weeks. However, eyes receiving bromfenac had a higher mean IOP at 2 h post-op (22.1 mmHg) than eyes receiving flurbiprofen (18.8 mmHg) and a slower decrease in IOP in the weeks after surgery. Over the course of the study, a higher percentage of eyes receiving bromfenac had therapy discontinued over concerns of elevated IOP compared to eyes receiving flurbiprofen (bromfenac 23.1% and flurbiprofen 9.8%). On average, the risk of having elevated intraocular pressure with bromfenac is 1.04 times higher than with flurbiprofen. Conclusion Elevated postoperative IOP was observed in both treatment groups; however, bromfenac-treated eyes were more likely to require intervention for elevated IOP.

Purpose Elevated intra-ocular pressure (IOP) has been identified as a major risk factor for glaucoma. Additionally, extensive literature depicts a vascular dysfunction to exist in these patients. However, a large ocular blood flow-oriented trial to integrate these findings in the clinical setting is lacking. This study would likely help to identify which of these vascular data can be used as a clinical tool for screening and disease stratification. Method Prospective, cross-sectional, case–control hospital-based study. Patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), ocular hypertension (OHT), glaucoma suspects and healthy volunteers were recruited. In addition to a comprehensive ophthalmological examination, a vascular-oriented questionnaire was completed and ocular blood flow assessment (colour Doppler imaging of retrobulbar vessels, retinal oximetry, dynamic contour tonometry, optical coherent tomography enhanced-depth imaging of the choroid) were performed. Statistical analysis was based on multiple imputation to account for missingness. Results A total of 614 subjects (291 males) were recruited between March and December 2013 (POAG: 214, NTG: 192; OHT: 27; glaucoma suspect: 41; healthy controls: 140). Glaucoma groups (NTG and POAG) were age and gender matched with the control group (p > 0.05). Glaucoma groups were paired in terms of functional and structural parameters (p > 0.08). Mean ocular perfusion pressure was higher in the glaucoma groups than in controls (p

This is the protocol for a review and there is no abstract. The objectives are as follows: The objectives of this review are to examine the comparative effectiveness and safety of different glaucoma fixed combination therapies and monotherapies in eyes with primary open angle glaucoma or ocular hypertension and to provide relative rankings of these treatments.

A seven-year eight-month-old, female entire, Staffordshire Bull Terrier presented with bilateral third eyelid protrusion, polyuria, polydipsia and respiratory stridor. Diabetes mellitus and acromegaly were diagnosed, suspected to be secondary to elevated circulating endogenous progestogen levels. These elevated levels occur during the luteal phase of the oestrus cycle. The finding of bilateral ocular hypertension is proposed to be secondary to the acromegaly. The ocular hypertension resolved post-ovariohysterectomy and mammary mass removal, along with the resolution of the acromegaly. This case highlights an unusual presentation for acromegaly and demonstrates the value of tonometry even in cases where glaucoma seems unlikely. To the authors’ knowledge, this is the first report of ocular hypertension secondary to acromegaly in the dog.