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Abstract #27508 Published in IGR 12-4
Clinical utility and differential effects of prostaglandin analogs in the management of raised intraocular pressure and ocular hypertension
Lee AJ; McCluskey PClinical Ophthalmology 2010; 4: 741-764
Prostaglandin analogs (PGA) are powerful topical ocular hypotensive agents availablefor the treatment of elevated intraocular pressure (IOP). Latanoprost 0.005% and travoprost 0.004%are prodrugs and analogs of prostaglandin F2<. Bimatoprost 0.03% is regarded as a prostamide,and debate continues as to whether it is a prodrug. The free acids of all 3 PGAs reduce IOP byenhancing uveoscleral and trabecular outflow via direct effects on ciliary muscle relaxation andremodeling of extracellular matrix. The vast majority of clinical trials demonstrate IOP-loweringsuperiority of latanoprost, bimatoprost and travoprost compared with timolol 0.5%, brimonidine0.2%, or dorzolamide 2% monotherapy. Bimatoprost appears to be more efficacious in IOPloweringcompared with latanoprost, with weighted mean difference in IOP reduction documentedin one meta-analysis of 2.59% to 5.60% from 1- to 6-months study duration. PGAs reduce IOPfurther when used as adjunctive therapy. Fixed combinations of latanoprost, bimatoprost or travoprostformulated with timolol 0.5% and administered once daily are superior to monotherapyof its constituent parts. PGA have near absence of systemic side effects, although do have othercommonly encountered ocular adverse effects. The adverse effects of PGA, and also those foundmore frequently with bimatoprost use include ocular hyperemia, eyelash growth, and peri-ocularpigmentary changes. Iris pigmentary change is unique to PGA treatment. Once daily administrationand near absence of systemic side effects enhances tolerance and compliance. PGAs are oftenprescribed as first-line treatment for ocular hypertension and open-angle glaucoma. (copyright) 2010 Lee and McCluskey, publisher and licensee Dove Medical Press Ltd.
P. McCluskey. Sydney Eye Hospital, 8 MacQuarie Street, Sydney NSW 2000, Australia. pmccluskey@eye.usyd.edu.au
Classification:
11.4 Prostaglandins (Part of: 11 Medical treatment)
