The edition · Ophthalmology
Peak pressure, not mean pressure, is what the field follows
A repeat trabeculectomy cohort finds the postoperative pressure spike predicts field loss where the average does not; three ordinary anti-inflammatory drugs track lower rates of sight-threatening retinopathy; and only half of grafts survive three years in an eye with a drainage device.
The edition in brief
Today's ophthalmology edition opens with a propensity-matched analysis of more than 18,000 matched pairs per drug in a United States network, finding cetirizine, ibuprofen and prednisone each associated with substantially lower three-year incidence of diabetic macular oedema and proliferative retinopathy in type 2 diabetes — hazard ratios between 0.36 and 0.63, with fenofibrate as a positive control performing similarly and gabapentin as a negative control showing nothing. This is observational and should change no prescription, but the design is unusually careful and the signal is worth knowing. A meta-analysis of 22 retrospective studies and 943 grafts reports pooled 36-month endothelial keratoplasty survival of 57% overall and 50% in eyes with a previous glaucoma drainage device, with endothelial cell loss of 63% by 12 months in those eyes — figures that belong in the consent conversation. A nested case-control study in more than a million men from United Kingdom primary care found erectile dysfunction medication associated with primary open-angle glaucoma, with odds ratios of 1.29 and 1.17 across two datasets, which the authors read as vascular rather than pharmacological. A 25-centre randomised trial showed a preservative-free tafluprost/timolol fixed combination lowered diurnal pressure by a further 1.3 mmHg over tafluprost alone with less conjunctival hyperaemia. The practice-changer is a cohort of 186 eyes after failed trabeculectomy, where repeat trabeculectomy and Ahmed valve gave similar field progression, but postoperative peak intraocular pressure — not mean — carried an 11% increase in deterioration risk per mmHg.
Three ordinary drugs track less sight-threatening retinopathy
Hypothesis-generating only: three commonly used anti-inflammatory drugs were associated with markedly less vision-threatening retinopathy, but nothing here justifies prescribing any of them for the eye.
Half of grafts fail by three years in a drainage-device eye
Tell a patient with a glaucoma drainage device that about half of endothelial grafts are still working at three years — and plan for a regraft as part of the conversation, not as a surprise.
A vascular clue to glaucoma from an unlikely prescription
Treat erectile dysfunction medication as a marker of vascular risk rather than an eye risk — there is no case for stopping it, and no case for screening on it either.
The fixed combination bought 1.3 mmHg and fewer red eyes
A preservative-free tafluprost/timolol fixed combination gives about 1.3 mmHg more than tafluprost alone with less conjunctival hyperaemia — useful where redness is limiting adherence, subject to the usual beta-blocker contraindications.
Ask when the drop goes in, not whether it goes in
Ask what time the drop goes in and watch the patient instil one, rather than asking whether they are using it.
It is the pressure spike that costs the field
After glaucoma surgery, act on the highest pressure the eye has recorded rather than the average — each mmHg of postoperative peak carried an 11% higher risk of field deterioration.
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