CLINICAL SCENARIO: A 46-year-old male consulted for refraction. Best-corrected visual acuity was 20/20 for both eyes (OU), Jaeger 1 for near. Slit-lamp examination was normal. Intraocular pressure (IOP) was 25 mm Hg OU. Gonioscopy revealed iridocorneal angles that were open up to the ciliary body band OU. Funduscopy revealed clear media with no exudates or hemorrhages in the retina. Cup-disc ratio was 0.7 vertically and 0.6 horizontally with notching of the inferotemporal neuroretinal rim OU. Automated visual-field examination showed superior arcuate scotomas OU with no threat to fixation. The working diagnosis upon consultation was primary open-angle glaucoma. After all treatment options had been explained to the patient, a trial of medical therapy was chosen. Given the severity of the glaucoma, a target IOP range was initially set at 15 to 17 mm Hg. Nonselective beta-adrenergic blockers and prostaglandin analogues are two classes of medications that will most probably lower the IOP to the desired levels CLINICAL QUESTION: Among patients undergoing initial medical therapy for primary open-angle glaucoma, would latanoprost be more effective in lowering the IOP compared with timolol? SEARCH METHOD: An electronic literature search was performed using Medline (PubMed). The key words used were "latanoprost" and "timolol." The search was further limited to randomized clinical trials or metaanalysis published in the English language. Table 1 shows the search process performed The search was narrowed down to 5 articles. Abstracts of the articles were reviewed. One article employed ocular hypertensive subjects while another compared brimonidine and timolol. These studies were, therefore, excluded. Among all the metaanalyses obtained from the search, Zhang et al.s had the most number of subjects and outcome measures. It was for this reason that the article was chosen for appraisal in resolving the clinical scenario. (Author)
TIMOLOL

Infantile hemangioma is a common, benign tumor of infancy. Although systemic propranolol was found to be effective in the treatment of infantile hemangioma, its use is often challenging for clinicians owing to its potential side effects. Recent small studies have suggested that the topical use of timolol maleate gel, a non-selective beta-adrenergic antagonist, might be effective for the treatment of superficial infantile hemangioma. Here, we report three cases of infantile hemangioma of different sizes and depths treated with the topical timolol maleate gel-forming solution.
Hemangioma ; Propranolol ; Timolol*

PURPOSE: We conducted a study to evaluate the effects of brinzolamide/timolol fixed combination (BTFC) in normal-tension glaucoma (NTG) patients. METHODS: We reviewed the records of 33 normal-tension glaucoma patients treated with BTFC in the unilateral eye. We measured intraocular pressure (IOP) every 2 and 1/2 hours between 09:00 am and 04:30 pm. After using BTFC at 8:00 am and 8:00 pm for 6 months, we measured the IOP at the same time period. We analyzed and compared the IOP of eyes treated with BTFC and contralateral eyes. RESULTS: The mean reduction in IOP was -2.85 +/- 1.43 mm Hg (-18.36 +/- 8.58%) in the eyes treated with BTFC and -2.21 +/- 1.73 mm Hg (-13.90 +/- 10.66%) in the contralateral eyes. The IOP lowering effect was greater in the eyes treated with BTFC than in the contralateral eyes. After 6 months of BTFC instillation, the changes in IOP measurements were the lowest at 11:30 am and increased at each time point afterwards. The greatest reduction in IOP was observed at 1 month; however, significant IOP reduction was observed at 3 and 6 months in both BTFC and contralateral eyes. There was no serious adverse event causing ocular damage. CONCLUSIONS: BTFC provided a significant IOP reduction in both BTFC and contralateral eyes in NTG patients.
Glaucoma* ; Humans ; Intraocular Pressure ; Timolol*

The Korean 30 glaucoma patients, 38 eyes were examined. The intraocular pressure was measured by Goldmann applanation tonometer. It was estimated that the intraocular pressure drop rate by instillation of 0.5% timolol eye drops was average 27.7% compared to the intraocular pressure of pre-treatment. There were no significant correlation between intraocular pressure drop rate by instillation of 0.5% timolol eye drops and the height of intraocular pressure of pre-treatment. It was considered that there will be needed some other glaucoma medication added to 0.5% timolol eye drops when pre-treatment intraocular pressure is over the 40mmHg. No any significant side-effects of drug was observed.
Glaucoma ; Humans ; Intraocular Pressure ; Ophthalmic Solutions ; Timolol*

For the management of glaucoma it is essential to be well acquainted with the administered drugs-especially with their modes of action as well as any adverse reactions that may be involved. We should precisely determine the types of the disease and administer adequate drugs to control promptly. When expected effects are not obtained. However, we should immediately substitute other drugs for the previous ones and try to treat by medical therapy if possible. Furthermore, it is important to consider the education of the patients carefully in order to cooperate with doctor's instructions, therefore preventing blindness caused by glaucoma. Recently, newer drugs such as Dipinefrine and Timolol. Which are not only more potent than Pilocarpine and Epinephrine even in lower concentrations but have fewer adverse reactions, were developed and have been partly used. In the future, these drugs may be commonly used. However, a more through investigation is still needed to justify their widespread use.
Blindness ; Education ; Epinephrine ; Glaucoma ; Humans ; Pilocarpine ; Timolol

PURPOSE: To evaluate the characteristics of MUC2, MUC5AC expression and the effect of beta-blocker on MUC2, MUC5AC expression in cultured human conjunctival cell. METHODS: Human conjunctival cell was cultured. After obtaining the monoclonality of conjunctival cells, secondary culture was done. Cultured conjunctival cell was treated with 0.2 nM timolol. Specimen was collected in 1, 3, 5, 10 days after the confluence of cultured conjunctival cells. To determine the effect of beta blocker, Periodic acid-Schiff (PAS) staining, immunohistochemistry, RT-PCR, and flowcytometry were performed. RESULTS: Goblet cell was found in cultures of conjunctival cell. MUC5AC was detected in RT-PCR, immunohistochemistry, and flowcytometry, but MUC2 was detected only in flowcytometry. Beta blocker didn't have significant effects on expression of MUC2 and MUC5AC in flowcytometry. CONCLUSIONS: MUC2 and MUC5AC were detected in cultured conjunctival cell. Beta blocker may not affect goblet cell. The other factor will be related to goblet cell suppressing the mucin in long standing antiglaucomatous medication.
Goblet Cells ; Humans* ; Immunohistochemistry ; Mucins ; Timolol

PURPOSE: To investigate the effect of beta-adrenergics on the production of nitric oxide (NO) in cultured trabecular meshwork cells. METHODS: Primarily cultured porcine trabecular meshwork cells were exposed to timolol and to propranolol at various concentrations. Cellular survival was assessed by MTT assay and the production of nitrite was assessed by Griess reaction after 24 hours and 3 days respectively. Also investigated was the effect of co-administraton of timolol and isoproterenol. RESULTS: After exposure for 24 hours, neither drug affected the cellular survival. Timolol and propranolol inhibited the production of NO significantly (p<0.05). Isoproterenol abolished timolol-induced inhibition of NO production after 24 hours. These results were similar after exposure for 3 days. CONCLUSIONS: Both timolol and propranolol inhibit the production of NO in trabecular meshwork cells and isoproterenol abolished this effect. These results suggest that beta-adrenerics involves in the production of NO in trabecular meshwork cells.
Isoproterenol ; Nitric Oxide* ; Propranolol ; Timolol ; Trabecular Meshwork*

The Beta-adrenergic blocker(timolol maleate) decreases intraocular pressure by reducing the production of aqueous humor. Twenty patients scheduled to undergo cataract extraction were induced in study. After timolol maleate administration, we found the increase in the total protein concentration. By double-masked controlled study, 0.5% timolol maleate solution and normal saline were applied topically, and aqueous humor was aspirated during surgery. Total protein concentrations were determined by HPGFC. The total protein concentration as well as the concentration of high, medium and low molecular weight protein were elevated in the timololadministrated group. The relation of the levels of the three different molecular weight classes did not differ significantly between the timolol maleate group and the normal group.
Aqueous Humor* ; Cataract Extraction ; Humans ; Intraocular Pressure ; Molecular Weight ; Timolol*

The effect of 0.25% and 0.5% Timolol on intraocular pressure and concentration in aqueous humor was studied after topical instillation in the white rabbit. The intraocular pressure was measured with pneuma tonometer and the Timolol concentration in aqueous humor was measured with High Preformance Liquid Chromatograph after fine needle aspiration of aqueous humor at various time intervals. The results were as follows; 1. The percentage reduction of intraocular pressure increased with time and reached a peak after 3 hours. 2. The concentration of Timolol in aqueous humor increased with time and reached a peak after 3 hours. 3. There was close correlation between intraocular pressure and Timolol concentration in aqueous humor.
Aqueous Humor* ; Biopsy, Fine-Needle ; Intraocular Pressure* ; Timolol*

The aim of this study is to evaluate intraocular pressure (IOP)-lowering effects and side effects of 1%brinzolamide in its single use, and also in combined use with beta-blocker. Eighty normal eyes of 40 persons were randomized and divided into two groups: group A and B,20 persons each. In group A, patients had brinzolamide on unilateral eyes (subgroup A-1), and normal saline on the contralateral eyes (subgroup A-2). In group B, patients had 0.5% timolol and 1%brinzolamide on unilateral eyes and 0.5% timolol only on the contralateral eyes. IOP was measured before, 1/2,1,2,4 and 8 hours after instillation, respectively, and adverse effects were monitored. In both subgroups A-1 and B-1, the decrease of IOP was statistically significant compared with controls between 30minutes and 8 hours after instillation. Subgroup A-1 showed maximal decrease of IOP (22.2%) at 4 hours after instillation,while subgroup B-1 showed maximal decrease of IOP (48.3%) at 2 hours after instillation. Moreover,subgroup B-1 showed 12.1% of additional IOP-lowering effect on the average, compared with subgroup B-2. Out of the few adverse effects reported reported, bitter taste was the most common complaint. Brinzolamide might be used as a single agent or as an adjunct to betablocker for decreasing IOP in glaucoma patients. But further evaluation on more controls and patients of glaucoma or ocular hypertension through longer follow-up is required to support its clinical use.
Follow-Up Studies ; Glaucoma ; Humans ; Intraocular Pressure* ; Ocular Hypertension ; Timolol