ABSTRACT.Purpose: This study aimed to assess vascular endothelial function in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG) by measuring: (a) endothelium-dependent flow-mediated vasodilation (FMD) of the brachial artery, and (b) circulating endothelial progenitor cells, which are believed to support the integrity of the vascular endothelium. Methods:We enrolled 25 patients with OHT, 23 with POAG and 26 control subjects, all of whom were aged < 65 years and had no medical history of cardiovascular disease or cardiovascular risk factors. All subjects underwent a complete ophthalmological examination, biochemistry study, assessment of cardiovascular parameters, brachial artery ultrasound assessment of endothelium-dependent FMD, generic circulating progenitor cell (CPC) and circulating endothelial progenitor cell (EPC) count with the use of flow cytometry.Results: Flow-mediated vasodilation values differed significantly in OHT (4.5 ± 1.1%; p = 0.021) and POAG (4.0 ± 0.9%; p = 0.003) patients compared with controls (7.7 ± 0.8%). The CD34 + KDR + EPC count was markedly lower in OHT (28.0 ± 5.0; p < 0.001) and POAG (24.3 ± 3.4; p < 0.001) patients compared with controls (73.1 ± 8.1). Neither FMD not EPCs differed significantly between OHT and POAG patients. No significant differences in CPC count or cardiovascular parameters were found among OHT or POAG patients and controls. The levels of CD34 + KDR + EPCs were directly correlated (p = 0.043) with FMD, and inversely correlated (p = 0.032) with baseline intraocular pressure in OHT and POAG patients.Conclusions: Both OHT and POAG patients without cardiovascular risk factors have previously unreported severely reduced circulating EPCs and reduced FMD, both of which are indicators of endothelial dysfunction and increased risk of cardiovascular events.
. Purpose: The aim of the present study was to investigate how the medical treatment of glaucoma changed between 1997 and 2002, since the advent of prostaglandin derivatives, with regard to drug prescriptions and pharmaceutical costs. Methods: A study was made of medical prescriptions for 2228 patients with glaucoma and/or ocular hypertension, in order to investigate the following: (i) the antiglaucoma drugs most commonly prescribed in 1997 and 2002, and any differences between the drugs prescribed in these 2 years; (ii) the number of drugs used per patient in 1997 and 2002, respectively, and (iii) any increase in the prescribing of antiglaucoma drugs and their relative costs from 1997 to 2002. Results: From 1997 to 2002 there was a sharp drop in the prescribing of β‐blockers (79% in 1997 and 55% in 2002). A marked increase in the use of prostaglandin derivatives (0% in 1997 and 18% in 2002) was registered and a marked increase in the prescribing of carbonic anhydrase inhibitors (5% in 1997 and 14% in 2002) was also noted. From 1997 to 2002 there was a trend towards drug addition rather than substitution, so that the number of drugs used per patient increased. The number of patients treated increased enormously (by 98%) from 1997 to 2002. The cost of medical therapy from 1997 to 2002 rose dramatically, with an increase of 148.9% per patient. Conclusion: The availability of prostaglandin derivatives has strongly influenced the medical approach to glaucoma. This class of drugs will soon become the type most commonly prescribed for patients with glaucoma and/or ocular hypertension. The increased number of treatments also suggests that the approach of ophthalmologists towards these diseases has changed. Ocular hypertension, as well as glaucoma, is now treated more aggressively. Given the increase in the prescription of prostaglandin derivatives, the pharmaceutical cost of treatment has risen dramatically.
The fattening of beef cattle in Italy is mainly carried out under intensive rearing conditions. The main features of the Italian beef farms are the high stocking rate and the loose housing of the animals in multiple pens indoors. The pen with fully slatted floor is the most frequent housing solution because it does not require any bedding material and it has a lower labour cost to remove slurry
Aims: To evaluate, with fundus perimetry, the peripapillary differential light threshold (DLT) in eyes with glaucoma and ocular hypertension (OHT), and compare it with peripapillary retinal nerve fibre layer (RNFL) thickness. Methods: 35 glaucomatous, 29 OHT and 24 control eyes were included. Peripapillary DLT at 1˚from the optic nerve head was quantified with fundus perimetry; peripapillary RNFL thickness was measured over the same area by optical coherence tomography. Results: Mean (SD) peripapillary DLT was 19.2 (1.7), 17.6 (4.2) and 10.1 (6.9) dB in control, OHT and glaucomatous eyes, respectively (p,0.001). Mean (SD) RNFL thickness was 98.4 (35.3), 83.9 (35.1) and 55.8 (28.2) mm, respectively (p,0.001). Mean peripapillary DLT showed higher sensitivity and specificity in differentiating the three groups compared with RNFL thickness. Conclusion: Progressive, significant reduction of peripapillary DLT was documented in OHT and glaucomatous eyes compared with controls (p,0.001). DLT reduction parallels RNFL reduction.
Collagen shields have been used as therapeutic contact lenses to promote corneal epithelial healing and to deliver hydro-soluble drugs. In albino rabbits, we studied the ocular pharmacokinetics of netilmicin, an aminoglycoside antibiotic, released by a 24-hour collagen shield immersed for 10 min in commercially available eye solution of netilmicin, at the standard concentration of 3 mg/ml. The animals were sacrificed after 0.5,1, 6 and 18 h. The antibiotic concentrations were measured by the microbiological method. The drug levels remained above the MIC for the usual pathogens for 18 h in the cornea and for 6 h in the aqueous humor. In the iris and ciliary body the peak concentration was reached 1 h after shield application, netilmicin concentration decreased thereafter rapidly. The lens and the vitreous did not appear to be permeated by the drug. In the conjunctiva, drug concentrations were low, showing a negligible lateral diffusion of netilmicin released by shields. In conclusion, our findings show, that if the collagen shields are used as delivery systems, a very concentrated drug solution is not required to obtain high and persistent levels of netilmicin in cornea.
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