Medical interventions for primary open angle glaucoma and ocular hypertension

Vass, Clemens; Hirn, Cornelia; Sycha, Thomas; Findl, Oliver; Sacu, Stefan; Bauer, Péter; Schmetterer, Leopold

doi:10.1002/14651858.cd003167.pub3

Cited by 86 publications

(40 citation statements)

References 62 publications

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“…As such, many types of interventions have been proposed for the treatment of glaucoma. There is a published Cochrane review of topical treatments for the prevention of progression or onset of glaucomatous optic neuropathy (Vass 2007). In this review, we updated our evaluation of the evidence regarding the effects of neuroprotective agents when used to treat glaucoma.…”

Section: Introductionmentioning

confidence: 99%

Neuroprotection for treatment of glaucoma in adults

Sena

Lindsley

2017

Cochrane Database of Systematic Reviews

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Background Glaucoma is a heterogeneous group of conditions involving progressive damage to the optic nerve, deterioration of retinal ganglion cells, and ultimately visual field loss. It is a leading cause of blindness worldwide. Open angle glaucoma (OAG), the most common form of glaucoma, is a chronic condition that may or may not present with increased intraocular pressure (IOP). Neuroprotection for glaucoma refers to any intervention intended to prevent optic nerve damage or cell death. Objectives The objective of this review was to systematically examine the evidence regarding the effectiveness of neuroprotective agents for slowing the progression of OAG in adults compared with no neuroprotective agent, placebo, or other glaucoma treatment. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 7), Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to August 2016), Embase (January 1980 to August 2016), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to August 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 16 August 2016. Selection criteria We included randomised controlled trials (RCTs) in which topical or oral treatments were used for neuroprotection in adults with OAG. Minimum follow-up time was four years. Data collection and analysis Two review authors independently reviewed titles and abstracts from the literature searches. We obtained full-text copies of potentially relevant studies and re-evaluated for inclusion. Two review authors independently extracted data related to study characteristics, risk of bias, and outcomes. We identified one trial for this review, thus we performed no meta-analysis. Two studies comparing memantine to placebo are currently awaiting classification until study investigators provide additional study details. We documented reasons for excluding studies from the review. Main results We included one multicenter RCT of adults with low-pressure glaucoma (Low-pressure Glaucoma Treatment Study, LoGTS) conducted in the USA. The primary outcome was progression of visual field loss after four years of treatment with either brimonidine or timolol. Of the 190 adults enrolled in the study, the investigators excluded 12 (6.3%) after randomization; 77 participants (40.5%) did not complete four years of follow-up. The rate of attrition was unbalanced between groups with more participants dropping out of the brimonidine group (55%) than the timolol group (29%). Of those remaining in the study at four years, participants assigned to brimonidine showed less progression of visual field loss than participants assigned to tim...

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Section: Introductionmentioning

confidence: 99%

Neuroprotection for treatment of glaucoma in adults

Sena

Lindsley

2017

Cochrane Database of Systematic Reviews

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“…PG analogues have come into favor among ophthalmologists as they are the most effective drugs for the treatment of ocular hypertension84 and maintain fewer systemic side effects compared with older β-blockers, miotics, and adrenergic agonists 85. Generally, bimatoprost, latanoprost, and travoprost are the PG analogues available.…”

Section: Preservative-free Pg Analoguesmentioning

confidence: 99%

Efficacy and patient tolerability of travoprost BAK-free solution in patients with open-angle glaucoma and ocular hypertension

Mirza¹,

Johnson²

2010

OPTH

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The medical treatment of glaucoma has evolved significantly over the past several decades. The main driving forces behind this evolution are the safety profiles and efficacy of these medications. Prostaglandin (PG) analogues are shown to be superior to older drugs in both efficacy and tolerability. Though there are much fewer side effects that manifest after using PG analogues, the adherence and compliance to medication regimens are surprisingly lower than expected. A commonly sited reason is the ocular irritation and inflammation with these medications. Much of this inflammation can be attributed to the preservative, benzalkonium chloride (BAK). The chronic clinical and subclinical inflammation becomes increasingly detrimental when filtration surgery fails from bleb fibrosis secondary to this hypercellularity. A BAK-free formulation of a PG analogues recently became available. BAK-free travoprost is reviewed here. It has demonstrated equal efficacy and less ocular surface toxicity than its preserved counterparts. It is expected to serve as an instrumental resource in managing ocular hypertension and glaucoma in patients who demonstrate significant sensitivity to BAK. More randomized, controlled, double-blind studies are encouraged to evaluate its improved safety and tolerability.

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“…GDD surgery has been shown to have a lower failure rate than trabeculectomy with similar reduction in intraocular pressure, fewer early complications and less need for additional glaucoma surgery (Vass et al. 2007; Van Aken et al. 2010; Gedde et al.…”

Section: Introductionmentioning

confidence: 99%

Donor sclera versus bovine pericardium as patch graft material in glaucoma implant surgery and the impact of a drainage suture

Wijsard

Haan

Rietveld

et al. 2018

Acta Ophthalmologica

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PurposeTo compare the use of human donor sclera with bovine pericardium as patch graft material for a glaucoma drainage device (GDD), with respect to the incidence of tube exposure, and to study the role of a drainage suture.MethodsAll GDD surgeries between 2010 and 2014 performed at the VU Medical Center were examined in this comparative, retrospective cohort study. A total of 244 cases were included; 163 in the human donor sclera cohort and 81 in the bovine pericardium cohort with a median follow‐up of 31 and 36 months, respectively. The primary outcome measure was occurrence of tube exposure. Survival analysis for tube exposure was carried out and Kaplan–Meier curves compared. Secondary outcomes were postoperative intraocular pressure (IOP), number of glaucoma medications and the effect of a drainage suture.ResultsIn the bovine pericardium cohort, eleven (13.6%) eyes developed tube exposure compared to none in the human donor sclera cohort. Their Kaplan–Meier survival curves differed significantly from each other (χ² = 21.1, p < 0.001, log‐rank test). Mean IOP and number of glaucoma medications did not differ significantly between patch graft materials at three months of follow‐up. The use of a drainage suture directly lowered IOP after surgery in both cohorts. Within the bovine pericardium cohort, eyes with a drainage suture experienced more tube exposure, although this difference was not statistically significant (p = 0.09).ConclusionHuman donor sclera leads to less tube exposure than bovine pericardium. A drainage suture directly lowers IOP after surgery. With bovine pericardium, but not with donor sclera, exposure tends to be enhanced by a drainage suture.

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Medical interventions for primary open angle glaucoma and ocular hypertension

Cited by 86 publications

References 62 publications

Neuroprotection for treatment of glaucoma in adults

Neuroprotection for treatment of glaucoma in adults

Efficacy and patient tolerability of travoprost BAK-free solution in patients with open-angle glaucoma and ocular hypertension

Donor sclera versus bovine pericardium as patch graft material in glaucoma implant surgery and the impact of a drainage suture

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