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Degenerative ocular conditions, such as age-related macular degeneration, diabetic retinopathy, retinal vein occlusions, and myopic degeneration, have become a major public health problem and a leading cause of blindness in developed countries. Anti-vascular endothelial growth factor (VEGF) drugs seem to be an effective and safe treatment for these conditions. Ranibizumab, a humanized monoclonal antibody antigen-binding fragment, which inhibits all biologically active isoforms of VEGF-A, is still the gold standard treatment for the majority of these pathological entities. In this review, we present the results of the most important clinical trials concerning the efficacy and safety of ranibizumab for the treatment of degenerative ocular conditions. [ABSTRACT FROM AUTHOR]

Background To quantify the levels of tissue inhibitor of metalloproteinase 4 (TIMP4) and its ratios with free metalloproteinases (MMP) in the aqueous humor of patients with primary open angle glaucoma (POAG), pseudoexfoliation syndrome (PXS) and pseudoexfoliative glaucoma (PXG) and to evaluate a possible imbalance between MMPs and TIMPs in these samples. Methods Free MMP2, MMP3, MMP9, TIMP1, TIMP2, TIMP4 concentrations and active levels of MMP2 and MMP3 were determined with immunoassay ELISA and activity assay kits in 168 aqueous samples. Results TIMP4 was elevated in glaucoma patients(POAG: 0.95 ± 0.49 PXG: 1.28 ± 1.38 pg/ml. p <0.001). POAG, PXS and PXG samples demonstrated higher MMP2, TIMP1 and TIMP2 concentrations (p < 0.001). Samples from the PXS and PXG groups had a lower total/active MMP2 ratio (p < 0.004 and p < 0.008 respectively). Stoichiometric analysis showed an overbalance of TIMPsover MMPs in both POAG & PXG groups,especially of TIMP4. Conclusion TIMP4 elevation is a novel finding in glaucomatous eyes. A disregulation of extracellular matrix homeostasis is suggested in POAG, PXS and PXG. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of tafluprost on the central corneal thickness (CCT) in patients with primary open-angle glaucoma (POAG). Methods: This was a prospective study and included 100 eyes of 54 patients with POAG. All patients received tafluprost 0.0015% (Saflutan®) once daily in one or both eyes. CCT was measured by using noncontact pachymetry prior to the treatment and after 6 and 12 months. Results: Mean CCT of all treated eyes ( n = 100) was 547.79 ± 29.48 μm at baseline, 535.61 ± 26.54 μm after 6 months and 533.55 ± 26.45 μm after 12 months (Student's t test, p < 0.0001). Ninety-three percent of all treated eyes showed a decrease of CCT. CCT reduction was more significant within the first six months of the treatment period (Student's t test, p < 0.0001). After 12 months, a CCT reduction >25 μm occurred in 5% of all treated eyes. There was a significant positive correlation between the magnitude of corneal thinning and the initial CCT (Pearson, r = 0.49, p < 0.0001) but not between the magnitude of corneal thinning and intraocular pressure (IOP) reduction (Pearson, r = 0.145, p = 0.15). Discussion: Long-term use of tafluprost may decrease the CCT in patients with POAG. Consequently, clinicians must be aware of prolongated CCT variations that may arise throughout the follow-up period for proper IOP targeting and management. [ABSTRACT FROM AUTHOR]

Background: To evaluate corneal hysteresis (CH) and corneal resistance factor (CRF) in keratoconic (KC) eyes before and after corneal collagen cross-linking (CXL). Furthermore, to determine potential correlations with a series of corneal and demographic factors. Methods: The study consisted of 50 KC eyes that underwent CXL. CH and CRF were measured by the ocular response analyzer (ORA). Correlations were attempted with uncorrected visual acuity (UVA), best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), mean keratometry (Km), astigmatism (Astig.), residual astigmatism, age, and gender. Fifty non-KC eyes served as controls. Results: CH and CRF (mean ± SD) for non-KC eyes were 10.1 ± 1.9 mmHg and 9.7 ± 2.4 mmHg respectively, while for KC eyes preoperatively they were 8.2 ± 1.4 mmHg ( p = 0.007) and 7.4 ± 2.3 mmHg ( p = 0.01) respectively. Non-significant differences were detected between preoperative and postoperative CH and CRF measurements in KC eyes ( p = 0.518 and p = 0.479 respectively). Significant correlations were found between ORA parameters and BSCVA, CCT, Km, Astig. and residual astigmatism. Conclusions: ORA parameters demonstrate significant differences between KC and non-KC eyes. Both CH and CRF present significant correlations with visual acuity and corneal parameters. CXL exerts a non-significant impact on ORA measurements. [ABSTRACT FROM AUTHOR]

Purpose: To determine the direct costs of therapy over 5 years of a European monotherapy cohort begun on a prostaglandin (PTG) versus timolol in patients with primary open-angle glaucoma or ocular hypertension. Methods: A retrospective, multicenter, active-controlled, observational study. Data were abstracted for European patients treated as initial monotherapy in 1996 or afterward, with 5 years of available records. Results: This study included 271 patients (166 on a PTG and 105 on timolol at baseline). The average cost/month/patient over 5 years was $45.47±12.61 for PTG and $31.50±15.47 for timolol ( P<0.001, based on German prices). After 5 years, although there was no difference in number of glaucoma medicines prescribed between groups (1.0 PTGs and 1.1 timolol, P=0.41), the timolol group demonstrated a higher intraocular pressure (17.7±2.9 vs. 16.5±3.0 mm Hg, P<0.001), more medication changes ( P=0.01), greater incidence of glaucomatous progression ( P=0.04), and less patients persistent on original monotherapy ( P<0.001) than the PTG cohort. Conclusions: Patients originally on timolol monotherapy have a lower cost of care over 5 years than those started on a PTG. However, timolol patients during follow-up may demonstrate a higher intraocular pressure, more progression, more medication changes, and lower persistency of the original monotherapy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the 24-hour intraocular pressure (IOP)–lowering effect of latanoprost and the dorzolamide/timolol fixed combination (DTFC) after 2 and 6 months of treatment. Design: Randomized, prospective, crossover comparison. Participants: Thirty-nine patients had primary open-angle glaucoma, and 14 patients had ocular hypertension. Methods: After a 6-week washout period, patients were randomized to either 6 months of treatment with the DTFC twice daily or latanoprost every evening and then crossed over to the opposite treatment for an additional 6 months. Main Outcome Measure: Mean 24-hour IOP after 2 and 6 months of treatment. Results: Fifty-three patients had an average 24-hour baseline IOP of 25.2±2.3 mmHg. After 6 months of treatment, 24-hour IOPs were 18.1±1.9 mmHg for the DTFC and 18.3±1.9 mmHg for latanoprost. Compared with 2 months of therapy, at 6 months the DTFC showed no significant change in mean 24-hour IOP, whereas latanoprost demonstrated a reduction of 0.3 mmHg (P = 0.01). The DTFC had more burning (P<0.001) and bitter taste (P = 0.01), whereas the latanoprost had more hypertrichosis (P = 0.02). Conclusions: After 6 months of therapy, the DTFC and latanoprost have clinically similar 24-hour IOP-lowering efficacies. [Copyright &y& Elsevier]

Objective: To evaluate 24-hour intraocular pressure (IOP) efficacy of latanoprost versus travoprost, each given every evening, in exfoliative glaucoma patients. Design: Prospective, observer-masked, crossover comparison. Participants: Forty patients with exfoliation glaucoma. Methods: Patients with a pressure of >24 mmHg were randomized to latanoprost or travoprost for an 8-week treatment period after a 6-week medicine-free period. Patients were then switched to the opposite treatment for the second period. At untreated baseline and at the end of each treatment period the IOP was measured at 6 am, 10 am, 2 pm, 6 pm, 10 pm, and 2 am. Main Outcome Measure: Diurnal IOP. Results: The mean 24-hour IOP was 25.1±2.5 mmHg at baseline, 17.8±2.1 mmHg on latanoprost, and 17.3±2.2 mmHg on travoprost (P = 0.001). Individual time points were similar between treatments, except at 6 pm when travoprost provided lower IOP (16.7±2.6 vs 17.9±2.5 mmHg, P<0.001). Adverse events showed more conjunctival hyperemia with travoprost (n = 15) than latanoprost (n = 6; P = 0.03). Conclusions: Latanoprost and travoprost both significantly reduce the 24-hour IOP from baseline in exfoliative glaucoma, but travoprost may demonstrate a greater hypotensive efficacy in the late afternoon. [Copyright &y& Elsevier]

Purpose: The aim of this study was to evaluate the efficacy and safety in ocular hypertensive or open-angle glaucoma patients changed to a latanoprost/timolol fixed combination (LTFC) from previous therapy. Methods: We employed a retrospective, multicenter, active-controlled study evaluating patients who had a previous therapy substituted with LTFC and had a 3-month follow-up. Results: In the 168 patients included in the trial, LTFC reduced the intraocular pressure (IOP) after switching from previous therapies: timolol (22.8 ± 3.5 to 19.0 ± 3.9 mmHg, N = 49, p ± 0.001), latanoprost (21.2 ± 3.8 to 18.3 ± 2.5 mmHg, N = 54, p ± 0.001), and a dorzolamide/timolol fixed combination (20.9 ± 2.4 to 20.0 ± 2.7 mmHg, N= 32, p ± 0.03). In switching from a latanoprost and timolol unfixed combination, the pressure changed from 18.3 ± 3.8 to 18.9v 3.0 mmHg (N = 33, p ± 0.38). LTFC was persistent in 131 (78%) patients within the 3-month treatment period. The most common adverse event with LTFC was conjunctival hyperemia, which occurred in patients not previously treated with latanoprost therapy (N = 16, 10%). Conclusions: LTFC generally provides reduced IOP and limited side effects when substituted for other common glaucoma therapies, while providing similar pressure when switched from its own individual components. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the epidemiological correlation between age-related macular degeneration and pseudoexfoliation syndrome in the inhabitants of the island of Crete (Greece). Subjects and Methods: A total of 777 persons (315 men and 462 women, aged 40-99 years), representing a randomized sample (1.43%) of the Cretan population, underwent slitlamp and fundus examinations according to protocol. The results were statistically analyzed. Results: The prevalence of pseudoexfoliation was 16.1% (21.3% in men and 12.6% in women) and that of maculopathy, 7.9% (11.7% in men and 5.2% in women). The conditions were significantly correlated with each other (P = .002). Also, both displayed a significant direct correlation with age and altitude (for pseudoexfoliation, P < .001 and P = .002 for age and altitude, respectively; for age-related macular degeneration, P<.001 for age and for altitude) and an increase in bilateral incidence with progressing age. Conclusions: The observed prevalences of pseudoexfoliation and maculopathy were lower than those reported in the mainland of Greece and other Mediterranean regions. The correlation between age-related macular degeneration and pseudoexfoliation syndrome may be explained by the relationship of each disease with age and altitude. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to examine the repeatability of Pentacam-derived anterior chamber volume measurements, and assess the level of agreement of anterior chamber volume measurements obtained with the Visante and the Pentacam imaging devices. Methods: Anterior chamber volume was calculated with the Pentacam device and the Visante using the Wang formula. Results were analysed by means of the Wilcoxon signed rank test, Bland-Altman analysis, Cronbach's alpha test and intraclass correlation coefficient. P-values <0.01 were considered statistically significant. Results: One randomly selected eye from each of 20 persons was analysed. Spherical equivalent ranged between −2.50 and +1.50 D, and their age ranged from 25 to 79 years (mean ± SD: 54.4 ± 19.2 years). Mean anterior chamber volume measured with Pentacam was 171.1 ± 39.6 µL (minimum: 103.0 µL, maximum: 236.0 µL), and mean anterior chamber volume measured by Visante was 171.4 ± 42.4 µL (minimum: 96.4 µL, maximum: 245.5 µL). There was no statistically significant difference between Pentacam and Visante measurements of the anterior chamber volume ( P = 0.691, Wilcoxon signed rank test). Cronbach's alpha and intraclass correlation coefficient for Pentacam were 0.998 and 0.991, respectively. Conclusions: Anterior chamber volume measurements obtained with the Visante using the Wang formula were in good agreement with the corresponding ones obtained with Pentacam. This recently described method is easy to perform and might contribute to both clinical and research settings. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic capacity of the Ocular Response Analyzer's keratoconus match index (KMI) and keratoconus match probability (KMP) classification in keratoconus-suspect eyes. Setting: Department of Ophthalmology, University Clinics Saarland, Homburg, Germany. Design: Comparative case series. Methods: The KMI and KMP parameters in keratoconus-suspect eyes and normal eyes (control group) were compared. The quantitative keratoconus percentage index was calculated for all suspect eyes. According to the thinnest corneal thickness (TCT), keratoconus-suspect eyes were divided into 2 subgroups: subgroup 1 (TCT <520 μm) and subgroup 2 (TCT >520 μm). The KMI's overall predictive accuracy was assessed using receiver operating characteristic (ROC) curves. The relationship between KMI and a series of Scheimpflug-derived keratoconus-related indices was evaluated using Spearman analysis. Results: The mean KMI was 0.41 ± 0.29 (SD) in the keratoconus-suspect group (50 eyes) and 0.94 ± 0.29 in the control group (50 eyes) (P<.001). Nonsignificant KMI differences were detected between the keratoconus-suspect subgroups (subgroup 1, 27 eyes; subgroup 2, 23 eyes) (P=.059). Nonsignificant correlations were found between Scheimpflug indices and the KMI. The KMP identified 27.65% of control eyes as keratoconus suspect and 10.71%, 28.57%, and 3.57% of keratoconus-suspect eyes as being normal, having mild keratoconus, or having moderate keratoconus, respectively. The ROC analysis for the KMI indicated a predictive accuracy of 94% (cutoff point 0.72). Conclusions: The KMI seems to be a valuable index in the early diagnosis of keratoconus-suspect eyes. The KMP identified a significant percentage of topographically defined keratoconus-suspect eyes as normal or keratoconic. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To determine the variability in Scheimpflug image–derived posterior elevation measurements in eyes with keratoconus or corneal collagen crosslinking (CXL). Setting: Eye Institute of Thrace, Alexandroupolis, Greece. Design: Prospective observational study. Methods: Two operators in 2 sessions obtained posterior elevation measurements using the Pentacam Scheimpflug system. Variability in measurements was assessed using Bland-Altman analysis and intraclass correlation coefficients (ICCs). Measurements were associated with a series of Scheimpflug-derived keratoconus indices using the Pearson correlation and multivariate linear-regression analysis. Results: Mean interobserver differences for the central elevation point (e1) and the highest elevation point (HEP) in the keratoconus group were −0.9 μm (95% limits of agreement [LoA], 5.7 to −7.5 μm) and 1.7 μm (95% LoA, 26 to −22.6 μm), respectively. In the CXL group, the mean differences were 0.2 μm (95% LoA, 6.0 to −5.5 μm) and −6.1 μm (95% LoA, 16.8 to −29 μm), respectively. The ICC values in the keratoconus group were satisfactory for most elevation points; the ICC values were unsatisfactory for a series of points in the lower corneal hemisphere. The ICC values for points in both hemispheres were unsatisfactory in the CXL group; HEP had adequate reproducibility. The e1 and HEP parameters correlated significantly with most Scheimpflug-derived indices (P<.05) in the keratoconus group but not in the CXL group. Regression analysis indicated that the central keratoconus index was the primary determinant of the variability in keratoconus eyes. Conclusions: Scheimpflug-derived posterior elevation measurements had acceptable reproducibility in keratoconus eyes and post-CXL eyes. Less consistent measurements were obtained in the lower hemisphere. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Purpose: To determine the efficacy of brimonidine tartrate 0.2% drops given 2 times a day in reducing intraocular pressure (IOP) spikes during the first 24 hours after phacoemulsification cataract surgery.Setting: Department of Ophthalmology, General Hospital of Patras Agios Andreas, Patras, Greece.Methods: In this prospective double-blind placebo-controlled study, 1 eye of 40 consecutive normotensive cataract patients having small-incision cataract surgery was randomized into 1 of 2 treatment arms. Twenty patients received a placebo (artificial tears) and 20 patients received brimonidine tartrate 0.2% drops 2 times a day the day before and the day of surgery. Diurnal IOP variation was the primary efficacy variable; IOP was measured at baseline, before surgery, and 4, 6, 12, and 24 hours postoperatively.Results: The placebo group had higher IOPs at every time point after surgery. Peak elevation of IOP occurred 6 hours after surgery. The mean IOP in the placebo group (27.71 mm Hg ± 3.75 [SD]) was statistically significantly higher than in the brimonidine group (21.45 ± 1.32 mm Hg) (P<.001). A major IOP rise (≥20 mm Hg above baseline IOP) occurred in 1 patient (5%) in the placebo group who required emergency hypotensive therapy. Twenty-four hours after surgery, 11 eyes (55%) in the brimonidine group and 4 eyes (20%) in the placebo group had an IOP lower than baseline.Conclusion: Prophylactic treatment with brimonidine tartrate 0.2% 2 times a day for 2 days was effective in reducing IOP peaks throughout the first 24 hours after phacoemulsification surgery. [Copyright &y& Elsevier]

To describe a case of conjunctival hyperaemia and proptosis of the right eye.Three-dimensional computed tomography (CT) was performed to reveal the size and position of a lesion of osseous density extending into the right orbit. The lesion was then excised using a right paranasal transcutaneous approach.The pathology report suggested ethmoidal osteoma. The postoperative course was uncomplicated and the lesion did not recur during a 5-year follow-up period. Repeated postoperative ophthalmic examinations revealed preservation of visual acuity and visual fields postoperatively.Diagnosis is based on imaging studies, especially CT and three-dimensional CT scans. A three-dimensional CT scan is critical in understanding the actual dimensions of the tumour and its relations with other structures. Surgical removal is indicated in cases with orbital matrix compression and displacement. A transcutaneous paranasal approach allows for increased exposure of affected structures. [ABSTRACT FROM AUTHOR]