J Korean Ophthalmol Soc.  2016 Sep;57(9):1386-1391. 10.3341/jkos.2016.57.9.1386.

Effect of a Preservative-free Dorzolamide/Timolol Fixed Combination on Elevated Intraocular Pressure after Vitrectomy

• Lee SH
• Lee W
• Seong GJ
• Byeon SH
• Kim SS
• Koh HJ
• Lee SC
• Kim M

• KMID: 2351868
• DOI: http://doi.org/10.3341/jkos.2016.57.9.1386

Abstract

PURPOSE
To verify the effect of preservative-free Dorzolamide/Timolol fixed combination (PFDTC) on intraocular pressure (IOP) elevation after vitrectomy.
METHODS
We retrospectively reviewed medical records of 33 patients who used PFDTC after pars plana vitrectomy. All patients' visual acuity and IOP was measured and symptoms of conjunctival irritation were investigated through survey and slit lamp examination.
RESULTS
Before vitrectomy, the mean IOP was 13.6 ± 4.4 mm Hg which was elevated to 31.7 ± 5.4 mm Hg after vitrectomy (p < 0.001) and applying eyedrop lowered the mean IOP to 17.2 ± 7.0 mm Hg (p < 0.001). Regardless of tamponade material type, all elevated IOP decreased (p < 0.001) and the IOP of all 33 eyes did not rise to over 30 mm Hg again. No additional surgery for IOP control was needed during two-month follow-up period. Of the 33 patients using PFDTC, patients who felt discomfort were five (15.2%) and no patients showed side effects severe enough to stop use of eyedrop.
CONCLUSIONS
PFDTC is an anti-glaucomatic agent which can reduce the IOP by inhibiting aqueous humor production. Without need for additional surgery, the eyedrop can effectively lower elevated post-vitrectomy IOP, with expectation of good patient compliance due to low risk of conjunctival irritation.

Keyword

Cosopt-S®; Eyedrops; Intraocular pressure; Preservative-free; Vitrectomy

MeSH Terms

Aqueous Humor
Follow-Up Studies
Humans
Intraocular Pressure*
Medical Records
Ophthalmic Solutions
Patient Compliance
Retrospective Studies
Slit Lamp
Visual Acuity
Vitrectomy*
Ophthalmic Solutions

Reference

References

1. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002; 109:1807–12. discussion 1813.

2. Fujii GY, De Juan E Jr, Humayun MS, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002; 109:1814–20.

3. Ibarra MS, Hermel M, Prenner JL, Hassan TS. Longer-term abdominals of transconjunctival sutureless 25-gauge vitrectomy. Am J Ophthalmol. 2005; 139:831–6.

4. Kellner L, Wimpissinger B, Stolba U, et al. 25-gauge vs 20-gauge system for pars plana vitrectomy: a prospective randomised abdominal trial. Br J Ophthalmol. 2007; 91:945–8.

5. Hayreh SS. Anterior ischemic optic neuropathy. IV. Occurrence abdominal cataract extraction. Arch Ophthalmol. 1980; 98:1410–6.

6. Kangas TA, Bennett SR, Flynn HW Jr, et al. Reversible loss of light perception after vitreoretinal surgery. Am J Ophthalmol. 1995; 120:751–6.

7. Sabates WI, Abrams GW, Swanson DE, Norton EW. The use of abdominal gases. The results of sulfur hexafluoride gas in retinal abdominal surgery. Ophthalmology. 1981; 88:447–54.

8. Yeon DY, Yoo C, Park JH, et al. Adherence to preservative-free dorzolamide/timolol fixed combination assessed by counting the unused single-dose units. J Korean Ophthalmol Soc. 2015; 56:906–10.

9. Shim JC, Choe CM, Seong GJ. A comparision of short term use abdominals and satety of timoptic (R) with those of cosopt (R) in normal Korean. J Korean Ophthalmol Soc. 2002; 43:1206–11.

10. Blaschke TF, Osterberg L, Vrijens B, Urquhart J. Adherence to medications: insights arising from studies on the unreliable link abdominal prescribed and actual drug dosing histories. Annu Rev Pharmacol Toxicol. 2012; 52:275–301.

11. Jaenen N, Baudouin C, Pouliquen P, et al. Ocular symptoms and signs with preserved and preservative-free glaucoma medications. Eur J Ophthalmol. 2007; 17:341–9.

12. Faulborn J, Conway BP, Machemer R. Surgical complications of pars plana vitreous surgery. Ophthalmology. 1978; 85:116–25.

13. Ghartey KN, Tolentino FI, Freeman HM, et al. Closed vitreous surgery. XVII. Results and complications of pars plana vitrectomy. Arch Ophthalmol. 1980; 98:1248–52.

14. Weinberg RS, Peyman GA, Huamonte FU. Elevation of intraocular pressure after pars plana vitrectomy. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1976; 200:157–61.

15. Aaberg TM, Van Horn DL. Late complications of pars plana abdominal surgery. Ophthalmology. 1978; 85:126–40.

16. Altamirano D, Mermoud A, Pittet N, et al. Aqueous humor abdominal after Nd: YAG laser capsulotomy with the laser flare-cell meter. J Cataract Refract Surg. 1992; 18:554–8.

17. Valone J Jr, McCarthy M. Emulsified anterior chamber silicone oil and glaucoma. Ophthalmology. 1994; 101:1908–12.

18. Fry LL. Comparison of the postoperative intraocular pressure with Betagan, Betoptic, Timoptic, Iopidine, Diamox, Pilopine Gel, and Miostat. J Cataract Refract Surg. 1992; 18:14–9.

19. Joo CK, Kim JH. Prostaglandin E in rabbit aqueous humor after Nd-YAG laser photodisruption of iris and the effect of topical indomethacin pretreatment. Invest Ophthalmol Vis Sci. 1992; 33:1685–9.

20. Kaji Y, Hiraki S, Hirata H. The effects of calcium antagonists on prostaglandin E2 reaction in rabbit eyes. Nippon Ganka Gakkai Zasshi. 1994; 98:825–31.

21. Chen PP, Thompson JT. Risk factors for elevated intraocular abdominal after the use of intraocular gases in vitreoretinal surgery. Ophthalmic Surg Lasers. 1997; 28:37–42.

22. Siegfried CJ, Shui YB, Holekamp NM, et al. Oxygen distribution in the human eye: relevance to the etiology of open-angle abdominal after vitrectomy. Invest Ophthalmol Vis Sci. 2010; 51:5731–8.

23. Gum GG, Kingsbury S, Whitley RD, et al. Effect of topical prostaglandin PGA2, PGA2 isopropyl ester, and PGF2 alpha isopropyl ester on intraocular pressure in normotensive and glaucomatous canine eyes. J Ocul Pharmacol. 1991; 7:107–16.

24. Neufeld AH. Experimental studies on the mechanism of action of timolol. Surv Ophthalmol. 1979; 23:363–70.

25. Neufeld AH, Bartels SP, Liu JH. Laboratory and clinical studies on the mechanism of action of timolol. Surv Ophthalmol. 1983; 28(Suppl):286–92.

26. Hutzelmann J, Owens S, Shedden A, et al. Comparison of the safety and efficacy of the fixed combination of dorzolamide/timolol and the concomitant administration of dorzolamide and timolol: a clinical equivalence study. International Clinical Equivalence Study Group. Br J Ophthalmol. 1998; 82:1249–53.

27. Boyle JE, Ghosh K, Gieser DK, Adamsons IA. A randomized trial comparing the dorzolamide-timolol combination given twice daily to monotherapy with timolol and dorzolamide. Dorzolamide-Timolol Study Group. Ophthalmology. 1998; 105:1945–51.

28. Pisella PJ, Pouliquen P, Baudouin C. Prevalence of ocular abdominals and signs with preserved and preservative free glaucoma medication. Br J Ophthalmol. 2002; 86:418–23.