The use of latanoprost 0.005% once daily to simplify medical therapy in patients with primary open-angle glaucoma or ocular hypertension.

PURPOSE: To evaluate the use of latanoprost 0.005% given once daily to simplify a patient's glaucoma medical regimen. METHODS: We reviewed 527 charts of which we included 61 patients (61 eyes) with either ocular hypertension or primary open-angle glaucoma who were prescribed latanoprost for the purpose of simplifying their glaucoma medical regimen. The successful substitution of latanoprost was defined as a reduction in the number of dosages given daily with the maintenance of intraocular pressure for at least three months no higher than 2 mmHg from the previous medical regimen. RESULTS: This study showed that 43 of 61 patients (70.4%) had latanoprost substituted allowing for fewer dosages per day. Following the substitution the intraocular pressure in the success group fell from 22.5+/-5.9 mmHg to 18.3+/-3.8 mmHg (p<0.001) over an average follow-up of 6.6+/-1.9 months. The total number of dosages per day in the success group fell from 4.8+/-2.4 to 1.7+/-1.3 at exit (p<0.001). Twenty-two patients had one medicine, 14 patients two, and seven patients three medicines discontinued after latanoprost was added. Reasons for failure after the substitution were ineffectiveness of latanoprost (n=11) or an adverse event (n=7). No trends in the number or types of medicines at baseline discontinued were observed in the success or failure groups. CONCLUSION: This study shows that latanoprost 0.005% once daily can be substituted for one or more medicines in the majority of ocular hypertension and primary open-angle glaucoma patients to simplify the medical regimen.

The use of latanoprost 0.005% once daily and its effect on intraocular pressure as primary or adjunctive therapy.

The purpose of this study was to evaluate differences in efficacy and safety of latanoprost as monotherapy compared to adjunctive therapy in primary open-angle glaucoma. We reviewed records of 527 patients who were treated with latanoprost as mono- or adjunctive therapy to reduce the intraocular pressure. Each patient was treated at least three months unless they were discontinued due to an adverse event or lack of efficacy. In the monotherapy group (n=49) baseline intraocular pressure of 23.6+/-5.2 mm Hg fell to 18.4+/-4.3 mm Hg after 4.4+/-2.0 months of follow-up; in the adjunctive therapy group (n=39) baseline intraocular pressure of 21.8+/-5.7 mm Hg fell to 16.7+/-4.6 mm Hg following 4.3+/-1.8 months of therapy which was a similar change from baseline for both groups (P > 0.9). No differences were noted in the class or number of medicines to which latanoprost could be added including: beta-blockers, alpha-agonists and topical carbonic anhydrase inhibitors. The reasons for failure with monotherapy were mostly adverse events (10/15 patients) and with adjunctive therapy lack of efficacy (14/16 patients). Latanoprost is similarly effective as monotherapy and as an adjunctive agent in reducing the intraocular pressure. Latanoprost can be added successfully to a variety of classes of glaucoma medicines used commonly as adjunctive therapy.

Latanoprost 0.005% and anterior segment uveitis.

PURPOSE: To evaluate the association of latanoprost with anterior chamber uveitis in glaucoma patients. METHODS: We retrospectively reviewed 527 charts in latanoprost treated patients with: no prior uveitis (Group 1); prior uveitis but were inactive at the time of the study (Group 2); and active uveitis (Group 3). RESULTS: In Group 1 five (1.0%) of 505 patients developed uveitis after beginning latanoprost. The uveitis was trace to 1+ cell in severity and delayed in onset 99.8+/-73.9 days In Group 2 three of 13 (23.1%) patients developed delayed uveitis (trace to 1+ cell). In Group 3 zero of nine (0%) patients had worsened inflammation and the intraocular pressure remained unchanged (22.8+/-7.8 mmHg to 22.0+/-7.3 mmHg) after beginning latanoprost (p=0.38). CONCLUSION: In patients without a prior history a mild delayed uveitis with latanoprost treatment may develop rarely. In patients with a uveitis history, a mild delayed exacerbation potentially may occur and the intraocular pressure may not be decreased in active uveitis.

The comparative ocular hypotensive effect of apraclonidine with timolol maleate in exfoliation versus primary open-angle glaucoma patients.

PURPOSE: To compare the effect of adding apraclonidine 0.5% to timolol maleate 0.5% in patients with exfoliation versus primary open-angle glaucoma. Since exfoliation glaucoma is known to demonstrate higher pressures than primary open-angle glaucoma on timolol maleate therapy alone, the authors wished to determine whether apraclonidine equalised the intraocular pressure (IOP) between these two glaucomas when added to timolol maleate. METHODS: We age-matched 30 consecutive exfoliation and 30 primary open-angle glaucoma patients who had an IOP > or = 22 mmHg on timolol maleate alone. Patients underwent IOP diurnal curve testing on timolol maleate twice daily alone and, 2 months later, following the addition of apraclonidine 0.5% three times daily. Statistical analysis of the IOP at each time point was by an unpaired t-test between groups. A paired t-test was used to evaluate the reduction in IOP from baseline within groups after the addition of apraclonidine. RESULTS: On timolol maleate alone, exfoliation patients had a higher mean IOP at 06:00 and 10:00 hours as well as a higher peak, range and standard deviation of the IOP compared with primary open-angle glaucoma patients (p < 0.05). Following the addition of apraclonidine the mean, peak and range of IOP were statistically similar between groups and only the standard deviations remained higher in the exfoliation glaucoma group (p < 0.001). The mean diurnal IOP after apraclonidine was added was 20.5 +/- 7.0 mmHg in the exfoliation glaucoma group and 20.0 +/- 3.4 mmHg in the primary open-angle glaucoma group, which was not significantly different between groups (p = 0.73). CONCLUSIONS: This study suggests that apraclonidine 0.5% used adjunctively with timolol maleate 0.5% solution is associated generally with similar IOP control in exfoliation and primary open-angle glaucoma patients.

The safety and efficacy of switching timolol maleate 0.5% solution to timolol hemihydrate 0.5% solution given twice daily.

This study was undertaken to evaluate the safety and efficacy of switching patients treated with timolol maleate to timolol hemihydrate. In patients with ocular hypertension or chronic open-angle glaucoma treated with beta-blockers for at least three months, we prescribed timolol maleate solution 0.5% given twice daily for one month. We then switched each patient to timolol hemihydrate solution 0.5% (Betimol, Ciba Vision Ophthalmics) given twice daily for three months. This study found over the first three months in 30 completed subjects, using a worse eye analysis, that the intraocular pressure changed from 18.3+/-2.1 mm Hg on timolol maleate to 18.8+/-2.3 mm Hg on timolol hemihydrate (P=0.10) 12 hours after dosing. There was no difference in the overall incidence of unsolicited anterior segment side effects between timolol maleate (4 cases) versus timolol hemihydrate (3 cases) (P=0.69). One patient exited the study because of pain and burning in both eyes while on timolol maleate. No patient was discontinued due to loss of intraocular pressure control after switching to timolol hemihydrate. It was concluded that switching from timolol maleate to timolol hemihydrate is safe and effective in maintaining control of the intraocular pressure.

Clinical presentation and initial treatment patterns in patients with exfoliation glaucoma versus primary open-angle glaucoma.

BACKGROUND AND OBJECTIVE: The presentation and initial response to treatment of consecutive patients with exfoliation glaucoma (PXE) and primary open-angle glaucoma (POAG) were evaluated prospectively. PATIENTS AND METHODS: Forty-six consecutive newly diagnosed patients with POAG and PXE were included in a prospective study that evaluated the initial clinical course and treatment results. The two groups were age- and race-matched. RESULTS: This study found no difference in optic disc parameters at presentation between patients with POAG (n = 22) and those with PXE (n = 24) (P > .05). However, the presenting mean defect was significantly worse in patients with PXE versus those with POAG (P = .0038), although the loss variance was similar (P > .90). The mean presenting intraocular pressure (IOP) for patients with PXE (32.0 +/- 5.2 mm Hg) was greater than that for patients with POAG (27.1 +/- 4.4 mm Hg) (P= .0025). Additionally, patients with PXE required more treatment steps to control IOP (P = .005). Thirteen of 24 patients with PXE versus 3 of 22 patients with POAG (P = .016) required either laser or conventional surgical techniques to reduce IOP. CONCLUSION: This study shows that patients with PXE have greater visual field loss and have more difficulty gaining control of IOP on presentation than patients with POAG.

Surgical vs medical management of chronic open-angle glaucoma.

PURPOSE: We studied patients with chronic open-angle glaucoma who had similar intraocular pressures to determine whether surgical or medical therapy is more effective in preventing progressive, long-term, glaucomatous damage. METHODS: Included in this study were patients with chronic open-angle glaucoma who were followed for 3 years or longer and were treated, through either medical or surgical therapy, by adjusting intraocular pressure to 18 mm Hg or less as a therapeutic end point. We studied 31 matched pairs of patients in which one member was treated by surgery and one member had medical treatment. In every pair, we matched each patient individually by age, race, and intraocular pressure. RESULTS: For the matched pairs of patients in this study, the mean intraocular pressure following initiation of treatment was 13.5 and 13.1 mm Hg for the surgically and medically treated groups, respectively (P = .475). This study found no difference between groups in the incidence of glaucomatous progression following surgical (n = 3) or medical (n = 3) therapy (P > .99, McNemar's test) for an average follow-up of 40.0 +/- 10.0 and 43.4 +/- 8.4 months in the medical and surgical groups respectively. The glaucoma of three patients progressed on the basis of reduced visual acuity, two by visual field, and one by disk hemorrhage. Although the types of complications from therapy differed between groups, no vision loss or life-threatening events occurred directly from these treatments. CONCLUSIONS: When intraocular pressure is used as a therapeutic end point, both filtration surgery and medical therapy appear to be equally effective in maintaining long-term visual function and a stable optic disk in chronic open-angle glaucoma.

Three-millimeter versus 6-mm incisions in combined phacoemulsification and trabeculectomy.

BACKGROUND AND OBJECTIVE: To determine the results of phacoemulsification and combined trabeculectomy in subjects receiving either a 3- or a 6-mm scleral incision. PATIENTS AND METHODS: The authors evaluated consecutive patients who underwent combined phacoemulsification and trabeculectomy with a 3-mm incision. These patients were individually matched by age, diagnosis, previous surgery, and race to those having a 6-mm incision. RESULTS: The study found that 1 year following surgery, results were similar between the 3- and 6-mm incision groups for intraocular pressure (IOP), bleb height, bleb vascularity, number of glaucoma medicines, anterior chamber depth, visual acuity, spherical equivalent, cylinder, and axis (P > .05). No difference was observed between groups with the highest IOP within the first postoperative month (P > .05). Also, no marked differences in number of complications were noted between groups. CONCLUSION: This study suggests that 3- and 6-mm incision phacoemulsification combined with trabeculectomy provide similar postoperative IOP control and visual acuity results.