Ocular Hypertension Treatment Study

Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study a randomized trial determines... 

Gordon MO, Beiser JA, Brandt JD, et al.The Ocular Hypertension Treatment Study baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002 120 714-720. 

Brandt JD, Beiser JA, Kass MA, Gordon MO (2001) Central corrreal thickness m the Ocular Hypertension Treatment Study (OHTS). Ophtlralmology 108 1779-1788. 

Feuer WJ, Parrish RK 2nd, Schiffinan JC, Anderson DR, Budenz DL, Wells MC, Hess DJ, Kass MA, Gordon MO (2002) Tlie Ocular Hypertension Treatment Study Reproducibility of cup/disk ratio measurements over time at an optic disc reading center. Am J Ophthalmol 133 19—28. 

Kass MA, Heuer DK, Higginbotliam EJ, Jolnison CA, Kellner JL, Miller JP, Parrisli RK 2nd, Wilson MR, Gordon MO (2002) Tlie Ocular Hypertension Treatment Study a r andomized trial detennrnes tliat topical ocular hypotensive medication delays or preverrts tlie orrset of primar y open-angle glaucoma. Ar ch Ophtlialmol 120 701—713. 

A 3-month study demonstrated identical lOP lowering efficacy between travoprost 0.004% with and without BAC in patients with open-angle glaucoma or ocular hypertension. In a double-masked multicenter study, patients were randomized to either travoprost 0.004% with BAC or travoprost 0.004% without BAC dosed once-daily in the evening. Mean lOP reductions ranged from 7.3 to 8.5 mm Hg for travoprost 0.004% without BAC and from 7.4 to 8.4 mm Hg for travoprost 0.004% with BAC. Adverse events were comparable between the two treatment groups. In one study conjunctival hyperemia occurred in slightly fewer patients treated with travoprost 0.004% without BAC than in patients treated with... 

One of the most common adverse events associated with the type of treatment is ocular hypertension. In one study intravitreal injections of 25 mg triamcinolone acetonide resulted in ocular hypertension in approximately 50% of treated eyes, commencing 1 to 2 months after the injection. lOP was responsive to topical therapy and normalized after approximately 6 months after the injection. Other studies reported that patients who feiled medical therapy required surgical intervention to reduce iatrogenic pressure elevations. 

Inclusion criteria for patients enrolled in the study included severe uveitis with posterior segment involvement with or without iridocyclitis, previous favorable response to oral or periocular corticosteroids, treatment-limiting side effects associated with systemic or periocular corticosteroids or systemic nonsteroidal immunosuppressive agents, intraocular pressure controlled at <21 mmHg with no more than one anti-ocular hypertensive drop and ability to attend follow-up visits. In total, seven eyes of five patients were included and the patients had a diagnosis of Bechet s syndrome or idiopathic panuveitis. The mean uveitis duration before device implantation was six years and the mean visual acuity was 20/207. 

CO-RM-3 has been employed in many in vivo experiments and it has been shown to exhibit many positive effects. Drago and co-workers have carried out experiments with rabbits, showing that administration of CO-RM-3 lowers intraocular pressure induced by a-chymotiypsin. The inactive form of CO-RM-3 does not lower intraocular pressure, suggesting the action of carbon monoxide in this treatment. These studies demonstrate a potential use of CO-RM-3 for the treatment of ocular hypertension. 

Pulmonary Two patients experienced serious adverse drug reactions. The first was an acute exacerbation of chronic obstructive pulmonary disease with dyspnoea in a patient who smoked and was diagnosed with ocular hypertension and chronic obstructive pulmonary disease. This was deemed probably related to study treatment. The episode resolved about 14 days after oral prednisolone treatment was initiated. Bimatoprost 0.01% was discontinued and the patient was switched to brinzolamide 1%. The second serious adverse drug reaction was an asthma attack in a patient with bilateral glaucoma and asthma. This was deemed possibly related to study treatment. The patient recovered about 2 weeks after discontinuation of bimatoprost 0.01% [37]. 

Systemic beta-blockers are used extensively far the treatment of hypertension and other cardiovascular disorders. Of the available oral beta-blockers, atenolol, metoprolol, nadolol, pindolol, propranolol, and timolol have been documented to produce a dose-dependent reduction in lOP. The ocular hypotensive effect associated with systemically administered beta-blockers can be compared with that achieved with topically applied beta-blockers such as timolol. Although specific studies have not been conducted with most of the remaining systemic beta-blockers, these agents might also be expected to reduce lOP at clinically useful doses. 

Corticosteroids have been investigated as a potential treatment for PVR. It has been hypothesized that they might directly inhibit cellular proliferation and suppress inflammation, and thereby prevent epiretinal and subretinal membrane formation (30). The safety and efficacy of corticosteroids to treat PVR have been demonstrated in animal studies (30-33). Systemic corticosteroids have been used to treat a variety of ocular and nonocular conditions in humans. Systemic side effects of corticosteroids are well-documented and include, among others, Cushingoid changes, osteoporosis, elevated serum glucose, hypertension, peptic ulcer disease, and psychiatric disturbance. 

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