Latanoprostene bunod (LBN) is a topical ophthalmic therapeutic for the reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension (OHT). LBN is composed of latanoprost acid (LA) linked to a nitric oxide (NO)-donating moiety and is the first NO-releasing prostaglandin analog to be submitted for marketing authorization in the United States. The role of latanoprost in increasing uveoscleral outflow of aqueous humor (AqH) is well established. Herein, we review findings from nonclinical studies, which evaluated the role of NO in the IOP-lowering efficacy of LBN. Pharmacokinetic studies in rabbits and corneal homogenates indicate that LBN is rapidly metabolized to LA and butanediol mononitrate (BDMN). NO is subsequently released by BDMN as shown by increased cyclic guanosine monophosphate (cGMP) levels in (1) the AqH and iris-ciliary body after administration of LBN in rabbits and in (2) human trabecular meshwork (TM) cells after incubation with LBN. LBN reduced myosin light chain phosphorylation, induced cytoskeletal rearrangement, and decreased resistance to current flow to a greater extent than latanoprost in TM cells, indicating that NO released from LBN elicited TM cell relaxation. LBN also lowered IOP to a greater extent than latanoprost in FP receptor knockout mice, rabbits with transient OHT, glaucomatous dogs, and primates with OHT. Along with results from a Phase 2 clinical study in which treatment with LBN 0.024% resulted in greater IOP-lowering efficacy than latanoprost 0.005%, these data indicate that LBN has a dual mechanism of action, increasing AqH outflow through both the uveoscleral (using LA) and TM/Schlemm's canal (using NO) pathways.
Neurotrophic keratopathy – the loss of corneal sensation – has a poor prognosis with limited available treatment options
Current techniques for corneal neurotization can restore corneal sensation, but may be associated with significant morbidity
I describe two minimally invasive techniques for corneal neurotization: using a cadaveric nerve graft and an endoscopic approach
More ophthalmologists learning – and performing – these minimally invasive procedures may help more patients before devastating and irreversible damage occurs.
Elizabeth Yeu, MD, discusses how the iStent Trabecular Micro-Bypass Stent (Glaukos) has given her the opportunity to provide an option at the time of cataract surgery that could prevent the progression of a patients' glaucoma. In this article, she describes her experiences with the iStent, which makes this option possible via microinvasive glaucoma surgery (MIGS).
Bhavana Sharma,1 Aditi Dubey,2 Gaurav Prakash,3 Rasik B Vajpayee4–6
1Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India; 2Department of Ophthalmology, Gandhi Medical College, Bhopal, India; 3Cornea and Refractive Surgery Services, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates; 4Vision Eye Institute, Melbourne, VIC, Australia; 5Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia; 6North West Academic Centre, University of Melbourne, Melbourne, VIC, Australia
Abstract: Surgical management of keratoconus (KC) has undergone a paradigm shift in the last two decades and component corneal transplantation technique of deep anterior lamellar keratoplasty has established itself as a modality of choice for management of advanced cases of KC. Every now and then, new minimalist modalities are being innovated for the management of KC. On the same lines, a new technique, Bowman’s layer transplantation, for surgical management of moderate to advanced KC has been reported in recent years. The procedure has shown to be beneficial in reducing ectasia in advanced KC with minimal intraoperative and postoperative complications. In this review, we intend to describe available information and literature with reference to this new surgical technique – Bowman’s layer transplantation.
Keywords: keratoconus, Bowman’s Layer, keratoplasty, post PRK haze, component keratoplasty
Purpose: Rho-associated protein kinase (ROCK) inhibitors lower intraocular pressure (IOP) by increasing aqueous outflow through the trabecular meshwork (TM). The preclinical characterization of netarsudil, a new ROCK/norepinephrine transporter (NET) inhibitor currently in clinical development, is presented herein.
Ocular infections, such as acute bacterial keratitis and postoperative endophthalmitis, can cause rapid, significant, and permanent visual impairment. Successful management requires early diagnosis, in addition to the correct antibiotic choice administered at appropriate therapeutic levels for the optimum duration, to eradicate the causative organism. This CME activity will discuss emerging delivery systems in the management of ocular infections.
Macular Vessel Density in Glaucomatous Eyes with Focal Lamina Cribrosa Defects
Ghahari, Elham MD*; Bowd, Christopher PHD*; Zangwill, Linda M. PHD*; Suh, Min Hee MD*,†; Shoji, Takuhei MD, PHD*,‡; Hasenstab, Kyle A. PHD*; Saunders, Luke J. PHD*; Moghimi, Sasan MD*; Hou, Huiyuan MD, PHD*; Manalastas, Patricia Isabel C. MD*; Penteado, Rafaella C. MD*; Weinreb, Robert N. MD*
Journal of Glaucoma: February 16, 2018 - Volume Publish Ahead of Print - Issue - p
Original Study: PDF Only
We might be in the age of vitrectomy, but we believe that scleral buckling is the treatment of choice for certain retinal detachments
But which patients are the best candidates for a primary scleral buckle and how should surgery be approached?
We overview when primary buckling should be considered and provide guidance on which techniques will help success, as well as when to avoid a primary buckle
Welcome to scleral buckling 101 for the senior ophthalmology resident and the junior retina fellow!
Mahmoud A Khaimi
Dean McGee Eye Institute, Oklahoma City, OK, USA
Background: While loteprednol etabonate (LE) suspension 0.5% is approved for the treatment of postoperative ocular inflammation, there have been no reported studies of its use in glaucoma patients undergoing canaloplasty.
Methods: This was a retrospective medical chart review conducted at a single US center. Data were collected on patients with glaucoma who underwent canaloplasty with or without cataract surgery, and were prescribed LE suspension 0.5% postoperatively. Outcomes evaluated included postsurgical inflammation (anterior chamber [AC] cells and flare), intraocular pressure (IOP), number of IOP-lowering medications, and postsurgical complications.
Results: Data were collected on 204 patients (262 eyes) with a mean (SD) age of 71.6 (11.3) years. The most frequent LE dosing regimens at day 1, week 1, and month 1 postsurgery were QID (92.3%; 241/261), TID (52.6%; 133/253), and QD (65.5%; 78/119), respectively. Inflammation (AC flare and cells), mostly mild, was noted in 33.2% (86/259) of eyes on postoperative day 1 and 8.6% (21/244) of eyes at month 1. Mean IOP and mean number of IOP-lowering medications were significantly reduced from baseline (P<0.001) at all time points postoperatively. Complete (no IOP-lowering medication) or qualified (use of ≤2 IOP-lowering medications) surgical success was achieved in 78.8% and 90.6% of eyes, respectively, at month 6 and 63.4% and 92.7% of eyes at month 36. The most frequently observed postoperative complication was hyphema in 48.7% (126/259) eyes at day 1, which decreased to 0.4% (1/244) of eyes by month 1. IOP ≥30 mmHg was noted in 13 (5.3%) eyes at postoperative week 1 and rarely thereafter, and no patient discontinued therapy because of an IOP increase.
Conclusion: These real-world data suggest that canaloplasty with or without cataract surgery managed postoperatively with LE suspension 0.5% is effective and safe in the glaucoma patient.
AcrivaUD Trinova is manufactured with Seamless Vision Technology (SVT) that is invented by VSY Biotechnology. The SVT is a unique patent pending technique to produce an IOL optical surface which does not exhibit any sharp edges. It provides best optical performance in trifocal IOL design. The lens shape is derived from sinusoidal functions and results in smoothly varying surface profiles. Therefore ideal continuous vision is achieved as opposed to common traditional overlapping diffraction pattern trifocal IOLs with sharp edges. This concept also helps to reduce halos and scattered light.
At a Glance
Cambodia has a small population of 15 million, but there are only 32 ophthalmologists – and only 23 who are surgically trained
The incidence of blindness is high and on the increase, despite 90 percent of all cases being preventable
The Khmer Sight Foundation (KSF) was initiated to bring eyecare to Cambodians who need it most
Here, we share the story of the first mission, and look to the future of KSF – and preserving the sight of the Cambodian population.
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