Topical latanoprost does not cause macular thickening after uncomplicated cataract surgery.

PurposeTo explore changes in central macular thickness (CMT) after a two-month period of glaucoma therapy with topical latanoprost after uneventful phacoemulsification.MethodsForty-one eyes of 31 patients with primary open angle or pseudoexfoliative glaucoma who required glaucoma medications after cataract surgery were prospectively enrolled. All eyes had undergone uneventful phacoemulsification with intraocular lens implantation at least 4 months before initiation of latanoprost. After a complete ophthalmic examination, spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) were performed at baseline before starting latanoprost. All eyes received latanoprost for 2 months, and clinical examinations were repeated one and two months afterwards; OCT and FA were repeated after 2 months. Outcome measures were CMT and loss of more than 2 lines of best corrected visual acuity (BCVA).ResultsMean patient age was 71.6±7.8 years. Intraocular pressure decreased from 21.5±3.4 mmHg to 14.4±2.6 mmHg (p<0.001) at 2 months. None of the eyes developed reduction of BCVA exceeding 2 lines, or angiographic cystoid macular edema (CME). Likewise no significant change was noted in CMT (249.9±29.8 vs 248.8±30.7µm), average macular thickness (274.5±15.0 vs 273.8±17.0µm), or macular volume (9.6±1.0 vs 9.6±1.1µm2) after treatment as compared to baseline (P>0.05 for all comparisons).ConclusionTopical use of latanoprost later than 4 months after uncomplicated cataract surgery does not seem to predispose to increased macular thickness or CME and may safely be used in this setting

Pharmacological mechanisms, clinical effectiveness, and side-effects of prostaglandin analogues as anti-glaucoma agents

Prostaglandin (PG)-related ophthalmic solutions, which only recently became available for clinical use, are currently the most widely used solutions in the treatment of glaucoma, because they have excellent ocular hypotensive effects with little adverse effects. With respect to the pharmacological mechanism of action of these solutions, the mechanism of intraocular pressure (IOP) reduction for latanoprost, the first drug in this class to become available, is to promote the outflow of aqueous humor through the uveoscleral route, an important aqueous humor outflow tract. Molecular and cellular studies have shown that latanoprost affects the extracellular matrix metabolism in the uveoscleral route. For other PG-related ophthalmic solutions, there is no consensus opinion on their effects on the aqueous humor outflow tract, and how they reduce the IOP remains largely unclear. The docosanoid, isopropyl unoprostone, has excellent ocular hypotensive effects, despite having extremely low affinities to the known PG receptors. Many basic and clinical studies have demonstrated that PG-related ophthalmic solutions themselves cause not only a decrease in the IOP, but also induce endogenous PGs which could lead to secondary effects that may account in part for the IOP reduction. PG-related ophthalmic solutions have essentially no clinically important systemic adverse effects, but often have local adverse effects. The most characteristic is the pigment deposition in the iris or eyelid. Corneal epitheliopathy is also relatively common. In addition, as an adverse effect that affects vision, cystoid macular edema can be seen. Current studies are aimed at elucidating the mechanisms of development of these adverse effects, and thus to establish measures to prevent them. We compare the mechanisms of action of PG-related ophthalmic solutions and review the adverse effects and their mechanisms.Biomedical Reviews 2002; 13: 17-27

Topical prostaglandin analogues and conjunctival inflammation in uveitic glaucoma.

A pilot study to determine whether topical prostaglandin analogues alter the expression of conjunctival inflammatory markers in patients with uveitic glaucoma.Prospective, single-masked case series of 20 patients with uveitis and secondary raised intraocular pressure. Participants were divided into four groups of five patients dependent on their use of topical medication: (1) prostaglandin analogues only, (2) corticosteroids only, (3) both prostaglandin analogues and corticosteroids, (4) no topical medication. Conjunctival cells were harvested by impression cytology and were examined for inflammatory markers (CD3, CD54, HLA-DR, CCR4, CCR5) by flow cytometry. A tear fluid sample was also examined for inflammatory cytokines (IL-12p70, IL-2, IL-10, IL-8, IL-6, IL-4, IL-5, IFN-gamma, IL-1beta, IFN-alpha, IFN-beta) by multiplex bead arrays.All groups demonstrated increased markers of conjunctival inflammation. There was no significant difference in levels of any inflammatory markers between the four groups, suggesting that the use of topical prostaglandin analogues does not increase conjunctival levels of inflammation beyond those already seen in uveitis.The use of topical prostaglandins does not appear to induce conjunctival inflammation over that which is already present in patients with uveitic glaucoma. This supports the use of topical prostaglandin analogues in patients with uveitic glaucoma, indicating that their use is unlikely to adversely affect subsequent glaucoma filtration surgery through the induction of chronic conjunctival inflammation

Effect of brimonidine on central corneal thickness in normal tension glaucoma patients

Background: Brimonidine is a potent ocular hypotensive agent widely used in glaucoma treatment. A reduction in central corneal thickness can lead to an underestimation of intraocular pressure by Goldmann applanation tonometry and vice versa. The aim of this study is to determine whether brimonidine has an effect on central corneal thickness.Methods: 30 eyes of patients who attended the Ophthalmology OPD between the time period October 2017 and June 2018 who were newly diagnosed with normal tension glaucoma with no history of any systemic illness or not on any medication were included. Each patient underwent a complete ophthalmic evaluation including fundus examination, visual field assessment, intraocular pressure, central corneal thickness measurement by pachymetry before as well as 1 month and 6 months after starting treatment with 0.2% topical brimonidine twice daily.Results: Administration of brimonidine 0.2% resulted in an increase in central corneal thickness from 525±21 µm before starting brimonidine to 528±21 µm (p<0.05) after 1 month and 535±20 µm (p<0.001) after 6 months. It also resulted in a reduction in intraocular pressure from an initial value of 16±2 mmHg before starting brimonidine to 14±2 mmHg (p<0.05) and 13±2 mmHg (p<0.05), 1month and 6 months after starting treatment, respectively.Conclusions: The data presented in this study show that topical administration of 0.2% brimonidine twice daily results in a significant increase in central corneal thickness in patients with normal tension glaucoma

Differential activity and clinical utility of latanoprost in glaucoma and ocular hypertension

Background: The purpose of this study was to demonstrate the hypotensive efficacy and tolerability of latanoprost when used as monotherapy and as polytherapy associated with antiglaucomatous medication proven to be ineffective in keeping intraocular pressure under control. Methods: Three hundred and thirty-seven patients (672 eyes) affected by primary open-angle glaucoma and intraocular hypertension were recruited over a period of 10 years from the Glaucoma Centre, Department of Ophthalmological Sciences, University of Rome "Sapienza", and treated, subject to informed consent, with latanoprost 0.005% alone or in combination with other ocular hypotensive drugs. The patients were followed during this period at regular intervals, with determination of visual field, fundus oculi, visual acuity, and eventual onset of local and systemic side effects. Results: Latanoprost used as monotherapy and as polytherapy renders possible optimal and durable control of intraocular pressure in the form of one antiglaucomatous drug because it can substitute for one or more drugs and obtain the same hypotensive effect. Conclusion: Latanoprost can be described as the ideal hypotensive drug, not only because of its ideal compliance profile (only one daily dose in the evening), excellent hypotensive effect, and, above all, few systemic side effects. © 2012 Pacella et al, publisher and licensee Dove Medical Press Ltd

Immunologic Corneal Graft Rejection after Administration of Topical Latanoprost: a Report of Two Patients

Purpose: To report endothelial corneal graft rejection after administration of topical latanoprost eye drops. Case Report: Two eyes of two patients with a history of multiple intraocular procedures prior to penetrating keratoplasty developed endothelial graft rejection one month after administration of topical latanoprost. Cystoid macular edema developed simultaneously in one patient. Conclusion: Latanoprost may trigger endothelial graft rejection in susceptible eyes