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Editors Selection IGR 14-4
Prostaglandins: Side effects
Comment by Stanley Berke on:
51955 Recovery from deepening of the upper eyelid sulcus after switching from bimatoprost to latanoprost, Sakata R; Shirato S; Miyata K et al., Japanese Journal of Ophthalmology, 2013; 57: 179-184
Prostaglandin analogs (PGAs) are the primary drugs to treat glaucoma, due to their efficacy, ease of use, and lack of systemic side effects. Prostaglandin Associated Periorbitopathy (PAP) has recently gained attention. PAP results from atrophy of periorbital adipocytes, and consists of ptosis, deepening of the upper eyelid sulcus (DUES), involution of dermatochalasis, loss of the inferior orbital fat pads, enophthalmos, inferior scleral show, and tight orbits. Sakata et al. report on 'Recovery from deepening of the upper eyelid sulcus (DUES) after switching from bimatoprost to latanoprost', a prospective, observer-masked, open-label study. In an earlier study, the authors found that switching 25 Japanese patients with OAG being treated in both eyes with latanoprost for more than 12 months to bimatoprost resulted in 15 patients (60%) developing DUES within six months. In the present study, the authors switched 13 of these 15 patients back to latanoprost, and found in 11 of the 13 patients (85%), DUES had either decreased or disappeared within two months, There were four men and nine women in the study, with a mean age of 56.9 years (range 37-68 years).
The authors concede several limitations to their study: small sample size, lack of control group, lack of pre-treatment photos, lack of side photos, not investigating other features of PAP, and a population limited to only Japanese patients.
In addition, the duration of bimatoprost use may be critical. They acknowledge that the high recovery rate seen 2 months after the switch back to latanoprost might have resulted from the short-term use of bimatoprost (only 6 months).
Recovery in cases of long-term PGA use should be investigated, and that further research needs to be done to determine the frequency of PAP, how long it takes to occur, how long it takes to resolve after discontinuation of PGAs, and any differences that may exist based on age, race, sex, and type of PGA used.
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