title: The effect of nebulized dorzolamide/timolol fixed combination mist versus drops on retrobulbar blood flow and intraocular pressure in glaucoma patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate intraocular pressure (IOP), retrobulbar blood flow (RBF), and ocular side effects after the application of topical dorzolamide/timolol fixed combination (DTFC) drops vs topical nebulized DTFC mist in patients with primary open-angle glaucoma.
  
  
  METHODS
  A total of 15 POAG patients were enrolled in a prospective study. Retrobulbar blood flow was measured in the ophthalmic (OA) and central retinal (CRA) arteries using color Doppler imaging. DTFC mist or drops were applied to the experimental eye, and it was examined after 15 and 60 minutes. DTFC mist was applied 6 times for 30 seconds using a misting device.
  
  
  RESULTS
  DTFC mist significantly increased peak-systolic (PSV) and end-diastolic (EDV) velocities after 15 and 60 minutes in both the arteries (OA: increase of 12.5% and 9.6% in PSV, P=0.01; increase of 25.8% and 23.1% in EDV, P=0.03; CRA: increase of 11.5% and 8.7% in PSV, increase of 32% and 21.6% in EDV, respectively, P<0.05). DTFC drops had a similar effect on PSV and EDV in the CRA after 15 and 60 minutes (increase of 8.1% and 9.6% in PSV; increase of 17.1% and 23% in EDV, respectively, P=0.03), but a significant effect on PSV and EDV in the OA was documented only after 15 minutes (increase of 9% and 21.4%, respectively, P=0.02). DTFC mist reduced the resistance index in the CRA after 15 and 60 minutes (decrease of 8.5% and 10.2%, respectively, P=0.04). Both methodologies showed a significant decrease in IOP after 15 and 60 minutes (P<0.05). All patients complained of ocular irritation after drop application, and 1 patient complained of general weakness after mist treatment.
  
  
  CONCLUSIONS
  Nebulized DTFC mist significantly reduced IOP and increased blood flow in the OA and the CRA, causing no ocular irritation as compared with traditional DTFC drop methodology.
authors.affiliation: Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, 50161 Kaunas, Lithuania. ingrida.januleviciene@kaunoklinikos.lt.
authors.forename: Ingrida
authors.initials: I
authors.lastname: Janulevičienė
authors.forename: Lina
authors.initials: L
authors.lastname: Šiaudvytytė
authors.forename: Rūta
authors.initials: R
authors.lastname: Baršauskaitė
authors.forename: Vaida
authors.initials: V
authors.lastname: Dilienė
authors.forename: Loreta
authors.initials: L
authors.lastname: Kuzmienė
authors.forename: Brent
authors.initials: B
authors.lastname: Siesky
authors.forename: Alon
authors.initials: A
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D009915:Orbit / Q000098:blood supply; D012039:Regional Blood Flow / Q000187:drug effects*; D013449:Sulfonamides / Q000008:administration & dosage*; D013876:Thiophenes / Q000008:administration & dosage*; D013999:Timolol / Q000008:administration & dosage*
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D009883:Ophthalmic Solutions; D013449:Sulfonamides; D013876:Thiophenes; C479140:dorzolamide-timolol combination; D013999:Timolol