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Garcia-Lopez A.,Fundacion Hospital de Nuestra Senora de la Luz | Paczka J.A.,University of Guadalajara | Jimenez-Roman J.,Asociacion para Evitar la Ceguera en Mexico APEC Hospital Dr. Luis Sanchez Bulnes | Hartleben C.,Institute Oftalmologia Conde Of Valenciana
BMC Ophthalmology | Year: 2015

Background: Fixed-combination ocular hypotensives have multiple advantages, but triple-therapy dorzolamide/brimonidine/timolol (dorz/brim/tim) is only available in Latin and South America, and information on its relative efficacy is limited. This study compares the efficacy and tolerability of fixed-combination bimatoprost/timolol (bim/tim) and dorz/brim/tim in Mexican patients with primary open-angle glaucoma or ocular hypertension. Methods: In this investigator-masked, crossover study, patients with unmet target intraocular pressure (IOP) on once-daily bim/tim or twice-daily dorz/brim/tim received the opposite medication for 3 months before returning to their pre-baseline medication for 3 months. IOP was evaluated before and after morning instillation at months 2, 3, 5 and 6. Primary endpoints were mean IOP change and Ocular Surface Disease Index © (OSDI) score at each visit. The intent-to-treat population was the a priori analysis population, but due to the number of discontinuations, the per-protocol and intent-to-treat populations were used for the primary efficacy and sensitivity analyses, respectively. Results: Seventy-eight and 56 patients were included in the intent-to-treat and per-protocol populations, respectively. At month 3, statistically significant IOP reductions from baseline were observed in the bim/tim (P < 0.01) and dorz/brim/tim (P < 0.0001) groups, regardless of assessment time. At month 6, patients returned to bim/tim exhibited no significant IOP increase (regardless of assessment time), but patients returned to dorz/brim/tim exhibited a statistically significant IOP increase (P < 0.001) when assessed before instillation of study treatment. Results were similar in both intent-to-treat and per-protocol analysis populations. In the per-protocol analysis, 70% of patients on bim/tim at month 3 had an IOP <14 mm Hg, which declined to 58% (P = 0.0061) at month 6 (ie, after 3 months of dorz/brim/tim treatment). In patients receiving dorz/brim/tim at month 3, 38% had an IOP <14 mm Hg, which remained comparable after return to bim/tim. OSDI scores and incidence of adverse events were similar in both groups. Conclusions: In this first direct comparison of the efficacy of dorz/brim/tim and bim/tim, patients switched from dorz/brim/tim to bim/tim demonstrated improved/lower IOP; when returned to dorz/brim/tim, IOP increased to levels seen at study initiation, suggesting that once-daily bim/tim may have greater IOP-lowering efficacy. Both bim/tim and dorz/brim/tim were well tolerated with minimal ocular surface damage. © 2014 García-López et al.; licensee BioMed Central.

Chew S.S.L.,University of Auckland | Vasudevan S.,University of Melbourne | Vasudevan S.,University Technology of MARA | Patel H.Y.,University of Auckland | And 6 more authors.
Ophthalmology | Year: 2011

Purpose To determine if an increased cup-to-disc ratio (CDR) and retinal nerve fiber layer (RNFL) loss occur after acute primary angle closure (APAC). Design Prospective, observational case series. Participants Twenty participants with unilateral APAC provided 20 affected eyes and 20 fellow eyes (controls) for analysis. Methods After initial presentation, participants attended 3 further assessments over a 12-month period (visit 2, within 2 weeks; visit 3, 23 months; and visit 4, 612 months), in which they underwent the following investigations: Heidelberg Retinal Tomography (Heidelberg Engineering, Dossenheim, Germany), optical coherence tomography of the RNFL and macula, and automated perimetry. Main Outcome Measures Cup-to-disc ratio, optic cup area, neuroretinal rim area, RNFL thickness, macular thickness, and volume. Results There was no change from visits 2 to 4 in CDR (0.46±0.17 vs. 0.47±0.20; P = 0.94), neuroretinal rim area (1.64±0.55 vs. 1.64±0.57; P = 0.96), or other optic nerve head parameters analyzed in eyes with APAC. The mean overall RNFL thickness decreased from 106.6±17.9 μm to 92.9±18.3 μm between visits 2 and 3 (P<0.01) in affected eyes. The superior quadrant RNFL thickness decreased from 134.8±25.9 μm to 113±25.7 μm (P<0.01), and the inferior quadrant RNFL thickness decreased from 139.1±28.4 μm to 115.6±24.9 μm (P<0.01). There was no significant change in macular thickness or volume. Conclusions This study demonstrated that an increase in CDR does not occur after APAC that is treated promptly, although RNFL loss does occur. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2011 American Academy of Ophthalmology.

Serna-Ojeda J.C.,Institute Oftalmologia Conde Of Valenciana | Pedroza-Seres M.,Institute Oftalmologia Conde Of Valenciana
British Journal of Ophthalmology | Year: 2014

Aim: To evaluate the clinical course of the patients with pars planitis that received immunosuppressive drugs. Methods: We retrospectively analysed the data of 10 years from 374 patients with pars planitis in a large reference centre in Mexico City and included 49 patients (92 eyes). Results: Median age at presentation was 8 years. 35 patients (71.4%) were male and 43 patients (87.7%) had bilateral disease. Diverse immunosuppressive medications were used, mainly methotrexate (69.4%) and azathioprine (63.3%) with 18 patients requiring more than one drug. The main indications for starting immunosuppressive therapy were lack of response to initial treatment and advance disease at presentation. The results showed good response with steroid reduction (69.3% of patients), visual acuity improvement (51% of patients) and inflammatory disease reduction (59.1% of patients). In 25 patients (51%), steroids were started previous to immunosuppressors and in 24 (49%) at the same time without significant difference in clinical improvement (p=0.210) or visual outcome ( p=0.498). Thirteen patients (26.5%) presented mild adverse effects. The median of the final visual acuity was 20/40. The median follow-up time was 44 months (range 13-115 months). Conclusions: Immunosuppressive therapy allows an adequate control of inflammatory disease in pars planitis, with clinical and visual improvement and steroid dose reduction.

Recillas-Gispert C.,Instituto Nacional Of Ciencias Medicas Y Nutricion Salvador Zubiran | Serna-Ojeda J.C.,Institute Oftalmologia Conde Of Valenciana | Flores-Suarez L.F.,systemIC
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2015

Purpose: The purpose of this descriptive study was to evaluate the clinical response to rituximab (RTX) in patients with scleritis due to granulomatosis with polyangiitis (GPA), in patients who had proved refractory to treatment with systemic glucocorticoids and immunosuppressive agents. Methods: Retrospective analysis of interventional case series. Single referral center study. Eight patients (12 affected eyes) due to scleritis secondary to GPA, refractory to conventional treatment were included to receive RTX as therapy for remission induction. RTX was administered as a 1-g infusion every 2 weeks, for a total of 2 g. Patient follow-up included clinical evaluation (systemic and ophthalmologic), B-cell subset (CD19, CD20, CD22) counts, proteinase-3 anti-neutrophil cytoplasmic antibody (PR-3 ANCA), and Birmingham Vasculitis Activity Score for Wegener's granulomatosis (BVAS-WG). Outcomes were response to treatment and achievement of remission, as well as number of ocular relapses. Results: The main indication for treatment was refractory necrotising anterior scleritis. Four weeks after completion of treatment with RTX, all patients showed clear clinical improvement, with no further progression. In all patients, an absolute depletion of B cells was confirmed in the first 6 weeks after treatment. Seven patients (87.5 %) achieved remission of inflammatory activity in 7 months or less. However, three patients experienced ocular relapse, which comprised reactivation of the anterior scleritis, uveitis, and posterior scleritis, and two patients required a second dose of RTX, with immediate improvement. Conclusions: RTX is useful in the treatment of refractory necrotising scleritis in patients with GPA. Of note, in those who relapse after remission, RTX can be successfully used for retreatment. © 2015, Springer-Verlag Berlin Heidelberg.

Hernandez-Camarena J.C.,Institute Oftalmologia Conde Of Valenciana | Hernandez-Camarena J.C.,Monterrey Institute of Technology | Graue-Hernandez E.O.,Institute Oftalmologia Conde Of Valenciana | Ortiz-Casas M.,Institute Oftalmologia Conde Of Valenciana | And 7 more authors.
Cornea | Year: 2015

Purpose: To report the distribution and trends in microbiological and antibiotic sensitivity patterns of infectious keratitis in a 10-year period at a reference center in Mexico City. Methods: In this retrospective observational case series, samples were obtained from corneas with a diagnosis of infectious keratitis from January 2002 to December 2011 at the Institute of Ophthalmology "Conde de Valenciana" in Mexico City. Results of cultures, stains, and specific sensitivity/resistance antibiograms for each microorganism were analyzed. Results: A total of 1638 consecutive corneal scrapings were analyzed. Pathogen was recovered in 616 samples (38%), with bacterial keratitis accounting for 544 of the positive cultures (88%). A nonsignificant increasing trend in gram-negative isolates (P = 0.11) was observed. The most commonly isolated pathogen was Staphylococcus epidermidis, and the most common gram-negative isolated species was Pseudomonas aeruginosa. Methicillin-resistant Staphylococcus aureus (MRSA) was present in 45% of the S. aureus isolates; meanwhile, 53.7% coagulase-negative Staphylococcus isolates were methicillin resistant (MRCNS). Pseudomonas aeruginosa resistance to ceftazidime increased from 15% in the first period to 74% for the last 5 years of the study (P = 0.01). The overall sensitivity for vancomycin of MRSA was 87.5%, whereas 99.6% of the MRCNS were sensitive. Conclusions: There was a nonsignificant increase in the recovered gram-positive and gram-negative microorganisms over time. We observed an increased resistance to methicillin in almost half of the MRSA and MRCNS isolates. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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