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European Journal of Ophthalmology / Vol. 19 no. 5, 2009 / pp. 790-797

Visual function, optic nerve structure, and ocular
blood flow parameters after 1 year of glaucoma

treatment with fixed combinations

1
2
INGRIDA JANULEVICIENE , RITA EHRLICH , BRENT SIESKY , IRENA NEDZELSKIENÉ , ALON HARRIS 2
2
3
1 Eye Clinic, Kaunas University of Medicine
2 Glaucoma Research and Diagnostic Center, Indiana University School of Medicine, Indianapolis - USA
3 Faculty of Odontology, Kaunas University of Medicine - Lithuania
PurPose. To compare the effects of latanoprost/timolol (LTFC) versus dorzolamide/timolol (DTFC) fixed
combinations on intraocular pressure (IOP), visual function, and retrobulbar blood flow in patients with
open-angle glaucoma (OAG).
Methods. This was a prospective, randomized, double masked, parallel study on 30 patients with OAG.
All patients received 4 weeks of timolol treatment prior to randomization to LTFC or DTFC treatment.
Measurements after randomization were taken at 1, 6, and 12 months, including arterial blood pressure;
IOP; color Doppler imaging of the ophthalmic artery (OA), central retinal artery, and short posterior ciliary
artery (SPCA); scanning laser polarimetry; Humphrey visual field examination; and adverse events.
results. IOP decreased by 5.0 mmHg in the DTFC cohort (p<0.000) and 5.44 mmHg in the LTFC co-
hort (p=0.0001) after 12 months of treatment. No statistically significant differences in visual field or
nerve fiber layer thickness were observed between the treatment groups during 12 months of therapy.
Mean increase over 1 year of treatment in ocular perfusion and diastolic perfusion pressures were
10.46% and 10.67% in the DTFC group and 7.47% and 5.61% in the LTFC group, respectively. OA
resistive index (RI) and SPCA RI were significantly different at the 12 months visit between the two
treatment groups (p=0.05 and p=0.000, respectively): DTFC treatment showed decrease in the RI.
ConClusions. One year of treatment with LTFC or DTFC resulted in similar IOP lowering effects as well
as stable visual function and structure. The DTFC group showed lower vascular resistance in retrobul-
bar vessels compared to the LTFC group. (Eur J Ophthalmol 2009; 19: 790-7)

Key Words. Fixed-combination treatment, Glaucoma, Optic nerve structure, Ocular hemodynamics,
Visual function
Accepted: February 26, 2009

INTRODUCTION for long-term glaucoma progression. The Advanced Glau-
coma Intervention Study (3) reported that different effects
Elevated intraocular pressure (IOP) is the major risk fac- on progression at different IOP levels may not appear until
tor for glaucoma; however, evidence on the importance of 5 years or later.
non-IOP-dependent glaucoma risk factors has emerged in The role of decreased blood flow in glaucoma formation
recent years. Systemic and local ocular blood flow param- and progression is under investigation. It is unclear wheth-
eters were found associated with glaucoma damage (1). er there is a primary contributing vascular component that
The EMGT (2) reported that 67% of patients progressed promotes damage to the optic nerve and retinal ganglion
over 11 years of follow-up. Lower systolic ocular perfu- cells (as well as aqueous humour dysregulation), if the open
sion pressure, cardiovascular disease, and low systolic angle glaucoma (OAG) vascular component is secondary
blood pressure were found to be significant risk factors to increased IOP, or if it represents a combination of the

1120-6721/790-08$25.00/0 © Wichtig Editore, 2009 Study results were partially presented as a poster at the 8th EGS, Berlin, June 2008

EJO_790-797_Janule.indd 790 3-08-2009 14:04:14

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