A compilation of latest medical and research updates that are worth sharing with glaucoma patients and care providers.

Deep Sclerectomy With Bevacizumab and Mitomycin C: A Comparative Study
Could Mitomycin-C (MMC) be dethroned as the preferred anti-scarring agent in Non-Penetrating Glaucoma Surgeries? At least with Deep Sclerectomy (often performed outside of the US) it appears that Bevacizumab (a drug most commonly used by retina specialists to treat “wet” macular degeneration) may be just as effective as MMC

Effect of 0.04% AR-13324, a ROCK, and Norepinephrine Transporter Inhibitor, on Aqueous Humor Dynamics in Normotensive Monkey Eyes
Experimental glaucoma medication both reduces fluid production and enhances fluid exit from the eye in monkeys. Known as AR-13324, this drug is part of a class of new and exciting glaucoma medications called ROCK/NET inhibitors.

Mitochondria-targeted antioxidant SkQ1 reverses glaucomatous lesions in rabbits
Could SkQ1, an experimental Russian eye drop, be used to treat glaucoma? Already approved for use in Russia as a treatment for dry eye syndrome, SkQ1 (brand name Visomitin) appears to have a neuroprotective effect that could be used to treat glaucoma. At least that’s what a rabbit study suggests.

Prospective Study on the Efficacy of Treating Normal Tension Glaucoma With a Single Session of Selective Laser Trabeculoplasty
Selective Laser Trabeculoplasty (SLT) may be a reasonable treatment for those with Normal/Low Tension Glaucoma (NTG/LTG) after all. According to this recently published study IOP was reduced by 20-30% after a single treatment with SLT.

Role of Subconjunctival Bevacizumab as an Adjuvant to Primary Trabeculectomy: A Prospective Randomized Comparative 1-Year Follow-up Study
Mitomycin-C (MMC) is still the King of anti-scarring agents for use with Trabeculectomy glaucoma surgery. A comparison with Bevacizumab (a drug most commonly used for macular degeneration) confirmed that the IOP reduction after this glaucoma surgery is greater with MMC.

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Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial Latanoprost not only lowers Intraocular pressure (IOP) but also preserves visual field. On the surface this may be seem obvious, but this is the first placebo-controlled trial to demonstrate this previously assumed benefit.

Trabeculectomy With Mitomycin C or Ahmed Valve Implantation in Eyes With Uveitic Glaucoma
Chronic inflammation in the eye (uveitis) can result in glaucoma that is quite challenging to treat. There is mounting evidence that trabeculectomy may not be the best surgical treatment option for uveitic glaucoma.

Micro-invasive suture trabeculotomy after canaloplasty: preliminary results
The Canaloplasty stent can be removed to achieve additional IOP lowering if needed. Although this technique has been informally discussed among experienced canaloplasty surgeons for years, a detailed description of the procedure and its results has been accepted for publication by a peer-reviewed journal.

Quality of life following glaucoma surgery: canaloplasty versus trabeculectomy
Quality of life better after canaloplasty than trabeculectomy. Although this is no surprise to me or my patients, it’s great to see this impression supported by clinical research.

The Difference in Intraocular Pressure Readings Between 3 Applanation Tonometers is Independent of Central Corneal Thickness, in Glaucomatous and Nonglaucomatous Eyes
In residency we used to call the Tonopen a “random number generator”. It seems we weren’t far from the truth. Looks like 2015 will be the year I swap out my Tonopens for the iCare tonometer.

Diabetes, Fasting Glucose, and the Risk of Glaucoma: A Meta-analysis
Another reason anyone diagnosed with diabetes should see an ophthalmologist for an exam: increased risk of glaucoma. A recent study confirms that those with diabetes are more likely to develop glaucoma. Additionally, the longer one has diabetes and the higher the fasting blood sugar the greater the risk of developing glaucoma.

The Interaction of Nepafenac and Prostaglandin Analogs in Primary Open-angle Glaucoma Patients.
Nepafenac, a non-steroidal anti-inflammatory drug (NSAID) appears to further lower intraocular pressure (IOP) in those who are already taking a prostaglandin analog. I wonder whether this effect would also be noted in those taking OTC oral NSAIDs such as naproxen or ibuprofen? Of course, taking an oral NSAID chronically could result in unwanted side effects such as stomach bleeding so this would not be a good option for treating glaucoma.

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Short-term Results of Trabeculectomy Using Adjunctive Intracameral Bevacizumab: A Randomized Controlled Trial
It would be great if we could finally eliminate Mitomycin-C (MMC) from trabeculectomy glaucoma surgery. Small steps are being made to this end. A recently published study evaluated the use of Bevacizumab (commonly used to treat “wet” macular degeneration) at the time of trabeculectomy. The results were promising but what we really need is a head-to-head study of Bevacizumab against MMC.

The Association Between Dry Eye Disease and Depression and Anxiety in a Large Population-Based Study
Dry Eye is associated with depression. Granted, an association does not imply that dry eye causes depression, but who would be surprised if chronically sore eyes and blurred vision resulted in depression? Use of glaucoma medications with the preservative BAK are known to worsen symptoms of dry eye disease.

Initial Clinical Experience With the CyPass Micro-Stent: Safety and Surgical Outcomes of a Novel Supraciliary Microstent
The CyPass Micro-stent lowers IOP and reduces glaucoma drop use one year after placement at the time of cataract surgery.

The Icare-Pro Rebound Tonometer Versus the Hand-held Applanation Tonometer in Congenital Glaucoma.
Although I don’t see children in my adult-focused practice, I’m seriously considering purchasing an i-Care Pro tonometer. Multiple studies have now shown good correlation with the gold standard of tonometry. The fact that it can be done without anesthetic eye drops would really be appreciated by my patients.

Valproic Acid Prevents NMDA-Induced Retinal Ganglion Cell Death via Stimulation of Neuronal TrkB Receptor Signaling

Valproic acid prevents retinal degeneration in a murine model of normal tension glaucoma.
Valproic acid, a common anti-seizure drug, may have a potential role in the treatment of glaucoma. Researchers evaluated two mouse models of glaucoma – both of which responded positively to valproic acid. This medication, however, is not without side effects. Indeed, the list is a long one. As such I would not expect this drug to be used to treat glaucoma except in rare situations. More likely this research will be used to evaluate potential future glaucoma drugs based upon this model of neuroprotection.

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