Biomedical subjects

W C Stewart

Publications and source records attributed to W C Stewart.

At least 55 records · Page 3Linked to original sources

PubMed1999

Perspectives in the medical treatment of glaucoma.

Many advances in medical therapy for chronic glaucoma have taken place in the past few years that have altered previous concepts of stepwise medical therapy for glaucoma. beta-adrenergic blockers are still the most common medicine prescribed as monotherapy. However, latanoprost and brimonidine are often given as monotherapy as well as early adjunctive therapy. In addition, newer treatments that are used as early adjunctive therapy are dorzolamide, brinzolamide, apraclonidine, and the combination products, consisting of dorzolamide/timolol maleate and pilocarpine/timolol maleate. Older adjunctive treatments are now often prescribed as late adjunctive therapy including pilocarpine, epinephrine compounds, and acetazolamide. The extent of maximum tolerated medical therapy and the decision to perform either laser or conventional filtration surgery depend on the physician's judgment and on the patient's needs and preferences. In the future, newer medical therapies that may protect the health of the optic nerve directly could be developed including blood flow-based, neuroprotective, and genetically based agents.

Adrenergic beta-Antagonists↗

PubMed1998

Salmonella typhimurium DT104 infection in people and animals in Scotland: a collaborative epidemiological study 1993-96.

This paper describes a comparative analysis of human and farm animal salmonellosis in Scotland between 1993 and 1996, with particular reference to Salmonella typhimurium definitive type 104 (DT104). Cattle were the main reservoir, accounting for 73.1 per cent of incidents involving all salmonellae and 69.5 per cent of those involving S typhimurium DT104. The annual rates of incidence in people and cattle were recorded in each Health Board area. Dumfries and Galloway had the highest rate of incidence in cattle for all salmonellae (19.0 per 100,000) but people were affected uniformly across mainland Scotland. However, the rate of incidence of S typhimurium DT104 was highest in Dumfries and Galloway for both people (10.1 per 100,000) and cattle (13.0 per 100,000). In Dumfries and Galloway, Wigtownshire had the highest rates for all salmonellae and for S typhimurium DT104 in both people and cattle. In Dumfries and Galloway, 37.8 per cent of the adult cases of S typhimurium DT104 in people were among those known to have had regular contact with animals, and children under six years of age accounted for 36.3 per cent of the human infections in this region.

Adult↗

PubMed1998

Beta-blocker-induced complications and the patient with glaucoma. Newer treatments to help reduce systemic adverse events.

Primary open-angle glaucoma is a condition associated with an elevated intraocular pressure (IOP) that is defined as optic degeneration with a slowly progressive deterioration of the visual field that may lead to blindness. More than 1 million Americans are being treated for glaucoma, and 80,000 are legally blind as a result of the disease. Glaucoma has its highest prevalence among the elderly population, with an incidence of approximately 1% in those older than 60 years, 3% in those between the ages of 70 and 80 years, and more than 9% in those older than 80 years. Treatment is directed at lowering high ocular pressures. The initial treatment, in most cases topical therapy with a beta-adrenergic blocking agent, reduces the IOP to help preserve sight. But such topical agents may also have adverse systemic effects on cardiac, pulmonary, central nervous system (CNS), and endocrine functions.

Adrenergic beta-Antagonists↗

PubMed1998

Acute and chronic regulation of Na+/K+-ATPase transport activity in the RN22 Schwann cell line in response to stimulation of cyclic AMP production.

Na+/K+-ATPase-dependent Rb+ uptake of RN22 Schwann cells was stimulated by cholera toxin (0.25 microg/ml), forskolin (2 mM), or 8-bromo cAMP (1 mM). At 2 h Rb+ uptake was increased by 162+/-6% (cholera toxin), 151+/-14% (forskolin), and 207+/-15% (8-bromo cAMP). Cholera toxin or 8-bromo cAMP treatment for 12-24 h resulted in a second peak of Na+/K+-ATPase-dependent Rb+ transport activity of 186+/-12 and 265+/-9% of control, respectively. Cholera toxin also transiently stimulated the activity of the Na+, K+, 2Cl- -cotransporter with a peak at 2 h (179+/-9%), returning to basal levels by 24 h. Inhibition of the Na+,K+,2Cl- -cotransporter by bumetanide (0.1 mM) or by reduction of the Na+ gradient (10 mM veratridine treatment) prevented the early peak in ATPase activity but not the second peak. These results indicated that the early transient stimulation of Na+/K+ ATPase activity by cholera toxin was due to an increase in cellular Na+, secondary to stimulation of Na+,K+,2Cl -cotransport activity. Western blot analysis of cellular homogenates and purified membrane fractions showed that the second peak of Rb+ uptake activity was a result of translocation of transport protein from an intracellular microsomal pool to the plasma membrane. Rb+ uptake by dominant negative protein kinase A mutants of the RN22 cell was not stimulated by cholera toxin treatment (acute or chronic) confirming the cAMP/protein kinase A dependency of both acute and long-term regulation of transport activity. In the absence of a change in Michaelis constants or of an increase in total transport protein of cellular homogenates, neither a change in enzyme kinetics nor an increase in de novo synthesis of transport protein could account for the increase in transport activity.

8-Bromo Cyclic Adenosine Monophosphate↗

PubMed1998

Latanoprost treatment for glaucoma: effects of treating for 1 year and of switching from timolol. United States Latanoprost Study Group.

PURPOSE: To determine the efficacy and safety of latanoprost treatment for 1 year in glaucoma patients, and to evaluate the effects of switching from timolol to latanoprost therapy. METHODS: Latanoprost 0.005% was topically applied once daily without masking for 6 months in 223 patients with elevated intraocular pressure after previous treatment with latanoprost once daily or 0.5% timolol twice daily for 6 months in a multicenter, randomized, double-masked, parallel group study. RESULTS: Compared with baseline values before treatment, a significant (P < .0001) diurnal reduction in intraocular pressure of 6 to 8 mm Hg was maintained with minimal fluctuation for the duration of treatment. When treatment was switched from timolol to latanoprost, intraocular pressure was reduced by 1.5 +/- 0.3 mm Hg (mean +/- SEM; 8% change in intraocular pressure; 31% of the intraocular pressure reduction produced by timolol; P < .001) compared with the change in intraocular pressure in patients remaining on latanoprost therapy. Of the patients initially enrolled, 95% successfully completed treatment. There was a slight overall increase in conjunctival hyperemia in patients who switched from timolol to latanoprost, but no change in those who continued latanoprost. The timolol-induced reduction of resting heart rate returned to baseline levels after switching to latanoprost. Of the 247 patients treated with latanoprost during the masked and/or open-label studies, 12 (5%) demonstrated a definite (n = 4) or possible (n = 8) increase in iris pigmentation. CONCLUSIONS: Latanoprost is a well-tolerated ocular hypotensive agent that appears to be more effective than timolol in reducing intraocular pressure. The increase in iris pigmentation appears to be harmless but requires further investigation.

Adult↗

PubMed1998

Intraoperative intracameral carbachol in phacoemulsification and posterior chamber lens implantation.

PURPOSE: To evaluate the use of intraoperative intracameral carbachol in association with phacoemulsification and posterior lens implantation. METHODS: We prospectively randomly assigned 41 eyes (41 patients) to receive either placebo or a 50:50 dilution of carbachol 0.01% after intraocular lens insertion and phacoemulsification. RESULTS: Twenty-one eyes of 21 patients treated with intracameral carbachol showed a statistically significant (P = .0373) reduction in intraocular pressure (15.9 mm Hg) at 6 hours postoperatively compared with 20 eyes of 20 patients who had received placebo (20.4 mm Hg). At day 1, the carbachol group measured 15.0 mm Hg vs 17.6 mm Hg for placebo (P = .0376), and a 1.5-line improvement in visual acuity in the carbachol vs the placebo group was noted (P = .0263), which was maintained on glare testing. On quality of life testing using a modified SF-36 test, carbachol-treated patients within the first postoperative week more often attempted to descent stairs in both bright (P = .007) and dim (P = .037) light than did patients treated with placebo. At month 2, no difference was observed between groups except that depth of focus was statistically greater in the carbachol group (P = .025). Safety was similar between the two groups in terms of ocular and systemic adverse events. CONCLUSIONS: Patients treated with carbachol intracamerally after phacoemulsification and posterior chamber lens implantation demonstrate lower intraocular pressure within the first day postoperatively. These findings are associated with improved visual acuity and potentially greater ambulation in bright light within the first postoperative week.

Aged↗

PubMed1998

The safety and efficacy of switching timolol maleate 0.5% solution to timolol hemihydrate 0.5% solution given twice daily.

This study was undertaken to evaluate the safety and efficacy of switching patients treated with timolol maleate to timolol hemihydrate. In patients with ocular hypertension or chronic open-angle glaucoma treated with beta-blockers for at least three months, we prescribed timolol maleate solution 0.5% given twice daily for one month. We then switched each patient to timolol hemihydrate solution 0.5% (Betimol, Ciba Vision Ophthalmics) given twice daily for three months. This study found over the first three months in 30 completed subjects, using a worse eye analysis, that the intraocular pressure changed from 18.3+/-2.1 mm Hg on timolol maleate to 18.8+/-2.3 mm Hg on timolol hemihydrate (P=0.10) 12 hours after dosing. There was no difference in the overall incidence of unsolicited anterior segment side effects between timolol maleate (4 cases) versus timolol hemihydrate (3 cases) (P=0.69). One patient exited the study because of pain and burning in both eyes while on timolol maleate. No patient was discontinued due to loss of intraocular pressure control after switching to timolol hemihydrate. It was concluded that switching from timolol maleate to timolol hemihydrate is safe and effective in maintaining control of the intraocular pressure.

Aged↗

PubMed1998

The efficacy and safety of diclofenac 0.1% versus prednisolone acetate 1% following trabeculectomy with adjunctive mitomycin-C.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy and safety of diclofenac 0.1% versus prednisolone acetate 1% following trabeculectomy with adjunctive mitomycin-C. PATIENTS AND METHODS: The authors prospectively randomized chronic open-angle glaucoma patients who underwent trabeculectomy with adjunctive mitomycin-C to receive postoperatively either diclofenac 0.1% or prednisolone acetate 1% 4 times daily, to be tapered as inflammation resolved. RESULTS: In the diclofenac group (n = 14), the preoperative intraocular pressure of 30.4 +/- 13.1 decreased to 12.4 +/- 6.5 mm Hg at 6 months postoperatively. In the prednisolone acetate group (n = 12), the preoperative intraocular pressure decreased from 29.1 +/- 10.4 to 12.8 +/- 4.2 mm Hg at 6 months postoperatively (P = .85). The average number of medicines used 6 months postoperatively was 0.50 +/- 0.8 in the diclofenac group and 0.24 +/- 0.6 in the prednisolone acetate group (P = .36). Adverse events were similar between groups (P = .51). One patient in the diclofenac group underwent reoperation at 1 month due to uncontrolled intraocular pressure. CONCLUSIONS: This study shows that following trabeculectomy with adjunctive mitomycin-C, a similar intraocular pressure result may be expected when either diclofenac or prednisolone acetate is prescribed postoperatively for intraocular inflammation.

Aged↗

PubMed1998

The effects of unoprostone isopropyl 0.12% and timolol maleate 0.5% on diurnal intraocular pressure.

PURPOSE: To compare the effect of unoprostone isopropyl 0.12% to that of timolol maleate 0.5% solution given twice daily on the diurnal curve of intraocular pressure (IOP) in patients with primary open-angle glaucoma or ocular hypertension. METHODS: In this investigator-masked, single-center, parallel-group comparison, 36 patients with primary open-angle glaucoma or ocular hypertension were randomized in a 2:1 ratio to receive either unoprostone isopropyl 0.12% or placebo/timolol maleate 0.5% solution, respectively. A placebo-controlled diurnal curve on day 0 and active-controlled diurnal curves at weeks 2 and 4 were performed at 0, 2, 4, 6, 8, 10, 12, and 24 hours. At week 2, administration of unoprostone isopropyl twice daily was compared with administration of timolol maleate twice daily. At week 4, administration of unoprostone isopropyl three times daily was compared with administration of timolol maleate twice daily. RESULTS: At the 24-hour 8:00 AM trough at week 2, administration of unoprostone isopropyl twice daily decreased IOP from 23.4 +/- 2.0 mmHg at baseline to 19.3 +/- 4.4 mmHg, and timolol maleate reduced IOP from 24.4 +/- 2.6 mmHg to 17.5 +/- 2.9 mmHg. At the 8:00 AM trough at week 4, unoprostone isopropyl given three times daily produced an IOP of 19.6 +/- 3.3 mmHg and timolol maleate resulted in an IOP of 19.4 +/- 3.0 mmHg. No statistical differences between groups were observed at any time point during either diurnal curve. Safety was similar in the two treatment groups, with no differences between groups in conjunctival hyperemia, anterior segment inflammation, or iris color change. CONCLUSION: Results of this short-term pilot trial indicate that unoprostone isopropyl may be safe and effective in reducing IOP from baseline when given twice or three times daily.

Circadian Rhythm↗

PubMed1998

Efficacy and safety of timolol solution once daily versus timolol gel in treating elevated intraocular pressure.

PURPOSE: To evaluate the efficacy and safety of timolol hemihydrate once daily versus timolol maleate gel forming solution once daily in patients with primary open-angle glaucoma or ocular hypertension. METHODS: We prospectively randomized patients with primary open-angle glaucoma or ocular hypertension to receive either timolol hemihydrate 0.5% solution or timolol maleate gel forming solution 0.5% every morning. The primary efficacy variable was the 8:00 AM trough intraocular pressure (IOP) 24 hours after administration. RESULTS: Three months after initiation of therapy, baseline IOP had decreased from 23.6 +/- 1.9 mmHg to 18.3 +/- 2.8 mmHg in the group taking timolol hemihydrate (n = 22) and from 23.7 +/- 2.2 mmHg to 18.4 +/- 3.1 mmHg in the group receiving timolol maleate gel (n = 21) at the 24-hour trough level. This was not a significant difference between groups at 3 months. Also, no difference was observed between groups in the 2-hour post instillation IOP. Visual acuity was decreased in the group receiving timolol maleate gel compared with those receiving timolol hemihydrate one minute after instillation of study medicine at month 3. Otherwise, ocular and systemic safety were similar between groups. No differences between groups in cardiac pulse or systolic and diastolic blood pressure were observed. CONCLUSION: Timolol hemihydrate 0.5% solution given once a day appears to be as efficacious and safe in decreasing IOP as timolol maleate gel 0.5% given once a day.

Blood Pressure↗

PubMed1997

Diurnal intraocular pressure in untreated exfoliation and primary open-angle glaucoma.

OBJECTIVE: To describe and compare the diurnal intraocular pressure (IOP) variation in patients with exfoliation glaucoma (EXG) and primary open-angle glaucoma (POAG). PATIENTS AND DESIGN: We prospectively investigated consecutive Greek patients with newly diagnosed untreated EXG and POAG. All patients were admitted to our ophthalmology department for 24-hour IOP measurements according to a standard protocol. After matching for age, we compared 40 pairs of patients with these 2 glaucomas. RESULTS: Patients with EXG showed a significantly higher mean range of IOP (13.5 vs 8.5 mm Hg for POAG; unpaired t test, P < .001), higher maximum IOP (mean, 38.2 vs 26.9 mm Hg for POAG; unpaired t test, P < .001), and higher minimum IOP (mean, 24.7 vs 18.4 mm Hg for POAG; unpaired t test, P < .001) Patients with EXG more often demonstrated an IOP range higher than 15 mm Hg (35% vs only 7.5% for POAG). Importantly, in 45% of patients with EXG and 22.5% of patients with POAG, the peak level of IOP was found outside office hours. There was no significant difference in visual function (visual acuity, cupping, visual field) at diagnosis between the 2 glaucoma groups. CONCLUSION: Significant fluctuation in the diurnal curve of the IOP distinguishes EXG from POAG and may be an important factor in predicting any subsequent poor response to medical therapy.

Aged↗

PubMed1997

Daily cost of beta-adrenergic blocker therapy.

OBJECTIVE: To evaluate the daily cost of beta-blocker therapy among commercially available products. METHODS: Ten different beta-adrenergic blocker preparations, each in 10-mL bottles (except Timoptic-XE [Merck brand of timolol maleate gel-forming solution], which was in a 5-mL bottle), were acquired from a local pharmacy. Each of 10 subjects dispensed 10 drops from each bottle onto an analytical scale. The mean drop volume for each preparation was then calculated. The fill volume of each bottle and the amount of each medicine that was wasted upon dispensing also were determined. Additionally, 60 pharmacies in the United States were randomly chosen to determine the average cost of each preparation studied. Based on all data obtained, an average daily cost of each medicine was calculated. RESULTS: The generic formulation of timolol maleate (Falcon) ($0.55) and Betimol (Ciba Vision Ophthalmics brand of timolol hemihydrate) ($0.57) demonstrated the lowest cost per day of therapy. In contrast, Betoptic-S (Alcon brand of betaxolol hydrochloride) ($1.60) and Betagan (Allergan brand of levobunonol hydrochloride) ($1.35) had the highest daily cost of therapy. Ocupress (Otsuka America brand of carteolol hydrochloride) had the smallest drop volume (31 microL) and Timoptic-XE had the highest (49 microL). Most preparations were close to their stated bottle fill volume. The amount of wasted medicine varied and was least with Ocupress (27%) and greatest with Betoptic-S (54%). The mean pharmacy price for a 10-mL bottle was lowest for OptiPranolol (Bausch & Lomb brand of metipranolol) ($25.51) and Betimol ($28.28); Betoptic-S ($44.80) and Betagan ($43.67) were the most expensive. CONCLUSION: Although all commercially available beta-adrenergic blockers effectively lower intraocular pressure, one differential factor between medicines is cost, which may be influenced by the price at the pharmacy, volume of medication per bottle, drop size, and medicine wastage.

Administration, Topical↗

PubMed1997

Effect of timolol on the diurnal intraocular pressure in exfoliation and primary open-angle glaucoma.

OBJECTIVE: To describe and compare the diurnal intraocular pressure (IOP) variation in patients with exfoliation glaucoma (EXG) and primary open-angle glaucoma (POAG) who were treated with a solution of timolol maleate (0.5%) twice daily. DESIGN: Consecutive Greek patients who were newly diagnosed as having EXG or POAG were prospectively investigated; they underwent 24-hour diurnal IOP measurements first without therapy and then 6 months afterward while they were being treated with timolol maleate (0.5%). After matching for age, 38 pairs of patients with these 2 types of glaucoma were compared. RESULTS: Untreated patients with EXG had significantly higher IOP values for all time points assessed and a greater mean range of IOPs (11.8 mm Hg for EXG vs 7.6 mm Hg for POAG; P < or = .001). Following therapy with timolol maleate (0.5%) given twice daily, patients with EXG had higher IOP values for the measurements that were obtained at 6 and 10 AM, 10 PM, and 2 AM, a higher mean range of IOPs (7.0 mm Hg for EXG vs 5.6 mm Hg for POAG; P = .03), and a higher maximum IOP (mean, 24.9 mm Hg for EXG vs 20.9 mm Hg for POAG; P = .003). The reduction of the range of diurnal variation of IOP was more pronounced in patients with EXG than in patients with POAG (40% vs 26%; P = .04). Twenty-two (58%) of 38 patients with EXG and 20 (53%) of 38 patients with POAG had peak IOP values that were found outside office hours. Only 5 (13%) of the patients with EXG exhibited an IOP of 18 mm Hg or less at all time points compared with 12 (32%) of the patients with POAG (P = .05). CONCLUSION: Despite a greater initial IOP reduction in the patients with EXG treated with timolol, a higher IOP and significant fluctuation in the diurnal curve of IOP during the time in which patients received therapy still characterized EXG from POAG.

Adrenergic beta-Antagonists↗

PubMed1997

Cardiovascular effects of topical carteolol hydrochloride and timolol maleate in patients with ocular hypertension and primary open-angle glaucoma. Night Study Group.

PURPOSE: To compare the effects of topical timolol maleate 0.5% and carteolol hydrochloride 1% on pulse rate and blood pressure. METHODS: In a randomized, double-masked, parallel-design, multicenter clinical trial, we compared the effects of timolol and carteolol on pulse rate and blood pressure measured by 24-hour ambulatory blood pressure monitoring in 169 adult patients with either ocular hypertension or primary open-angle glaucoma. RESULTS: From noon to 8 PM, baseline mean pulse rate of 82 to 83 beats per minute (bpm) had decreased by 4 to 6 bpm in both groups after 4 weeks of therapy with timolol or carteolol. From midnight to 4 AM, the pulse rate in the carteolol group was significantly above baseline (P = .005), while the timolol group was significantly below baseline (P < .001). Four times as many patients became bradycardic (heart rate, < 60 bpm) on timolol (18.4%) as did patients on carteolol (4.5%) from midnight to 4 AM. More than twice as many patients exhibited a resolution of their bradycardia with carteolol (46.7%) as did patients treated with timolol (18.2%) from midnight to 4 AM. Overall cardiovascular adverse effects were reported significantly more frequently in the timolol than the carteolol group (P = .002). CONCLUSIONS: Timolol causes significantly lower mean heart rate during the nighttime and more nocturnal bradycardia than carteolol does in patients with ocular hypertension and primary open-angle glaucoma. These differences may be because of the intrinsic sympathomimetic activity of carteolol.

Administration, Topical↗

PubMed1997

Efficacy of carteolol hydrochloride 1% vs timolol maleate 0.5% in patients with increased intraocular pressure. Nocturnal Investigation of Glaucoma Hemodynamics Trial Study Group.

PURPOSE: To evaluate the ocular hypotensive effect and safety of carteolol hydrochloride 1% vs timolol maleate 0.5%. METHODS: One hundred seventy-six patients with ocular hypertension or primary open-angle glaucoma were randomly assigned to receive either carteolol 1% twice a day or timolol maleate 0.5% solution twice a day in a randomized, double-masked, multicenter, parallel-group, active-control comparison trial during a 3-month period. RESULTS: After 12 weeks, carteolol 1% reduced the mean +/- SE intraocular pressure from 25.0 +/- 0.3 to 19.5 +/- 0.3 mm Hg; timolol maleate 0.5% reduced the mean intraocular pressure from 25.2 +/- 0.3 to 19.6 +/- 0.3 mm Hg. The mean difference in trough intraocular pressure between carteolol and timolol maleate of -0.14 mm Hg was not significantly (P = .745) different (95% confidence limits, -0.97 to 0.70 mm Hg). Trough pulse and blood pressure also showed no consistent statistically significant differences between groups. The 2-hour postdose pulse, however, demonstrated a greater decrease in the timolol maleate than in the carteolol group (P < .001). Systemic and ocular signs and symptoms were similar between the groups except that the number of treatment-emergent reports of bradycardia was greater in the timolol maleate group (P = .039), and the carteolol group reported fewer ocular symptoms than the timolol maleate group did (P < .01). CONCLUSIONS: Both carteolol 1% and timolol maleate 0.5% are highly effective in lowering intraocular pressure when measured at the end of the dosing interval. Carteolol 1% demonstrates an ocular hypotensive effect and safety profile similar to those of timolol maleate 0.5% solution.

Adolescent↗

PubMed1997

L-deprenyl protects injured retinal precursor cells in vitro.

We evaluated the ability of L-deprenyl, a monoamine oxidase B-inhibitor (MAO-B), to preserve the viability of serum-deprived immortalized retinal precursor cells in vitro. We serum-deprived rat neural retinal ganglion cells immortalized by an incompetent retro virus. We instilled L-deprenyl in concentrations ranging from 0.01 to 100 microM. After 72 hours we performed a cell count of the L-deprenyl cultures and the control (no L-deprenyl instilled) with a hemocytometer and flow cytometry. We used transmission electron microscopy, DNA gel electrophoresis, and flow cytometry to determine the mechanism of cell death. This study showed that all five concentrations of L-deprenyl statistically increased the survival rate of immortalized retinal precursor cells at 72 hours in the serum-deprived medium (P = 0.01, ANOVA test). Ten microM and higher appeared to provide the greatest immortalized retinal precursor cell survival (12.7 x 10(-4) cells) compared to the control (5.8 x 10(-4) cells). Flow cytometry also demonstrated a higher percentage of surviving cells at 10 microM (80%) and 100 microM (76%) than with the control (58%) (P = 0.0017, chi2 test). Transmission electron microscopy, DNA electrophoresis, and flow cytometry showed that the mode of cell death was by apoptosis. This study suggests that L-deprenyl may be worthy of further investigation as a neuroprotective agent to treat chronic open-angle glaucoma.

Analysis of Variance↗

PubMed1997

Safety of beta-adrenergic blocker washout period in clinical trials.

We prospectively evaluated the safety of the washout period from topical beta-adrenergic blockers prior to clinical drug trials. In 30 consecutive patients optic disc parameters (neural rim, optic disc, peripapillary halo and atrophy areas, and venous/arterial diameters) did not change following washout (p > 0.05). Likewise, the mean defect and pattern standard deviation (Humphrey 30-2) did not change following washout (p > 0.05). This study suggests, generally, the safety of the washout period prior to clinical drug trials.

Administration, Topical↗

PubMed1997

Clinical presentation and initial treatment patterns in patients with exfoliation glaucoma versus primary open-angle glaucoma.

BACKGROUND AND OBJECTIVE: The presentation and initial response to treatment of consecutive patients with exfoliation glaucoma (PXE) and primary open-angle glaucoma (POAG) were evaluated prospectively. PATIENTS AND METHODS: Forty-six consecutive newly diagnosed patients with POAG and PXE were included in a prospective study that evaluated the initial clinical course and treatment results. The two groups were age- and race-matched. RESULTS: This study found no difference in optic disc parameters at presentation between patients with POAG (n = 22) and those with PXE (n = 24) (P > .05). However, the presenting mean defect was significantly worse in patients with PXE versus those with POAG (P = .0038), although the loss variance was similar (P > .90). The mean presenting intraocular pressure (IOP) for patients with PXE (32.0 +/- 5.2 mm Hg) was greater than that for patients with POAG (27.1 +/- 4.4 mm Hg) (P= .0025). Additionally, patients with PXE required more treatment steps to control IOP (P = .005). Thirteen of 24 patients with PXE versus 3 of 22 patients with POAG (P = .016) required either laser or conventional surgical techniques to reduce IOP. CONCLUSION: This study shows that patients with PXE have greater visual field loss and have more difficulty gaining control of IOP on presentation than patients with POAG.

Adrenergic beta-Antagonists↗