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Editors Selection IGR 21-4

Forms of Glaucoma: Ocular Hypertension

Comment by Luciano Quaranta on:

78941 A Long-term Safety Study of Latanoprost in Pediatric Patients With Glaucoma and Ocular Hypertension: A Prospective Cohort Study, Younus M; Schachar RA; Zhang M et al., American Journal of Ophthalmology, 2018; 196: 101-111

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This is the first large-scale study analyzing the long-term safety of latanoprost in a pediatric cohort affected by a mixed variety of glaucoma and ocular hypertension. As stated by the authors, latanoprost showed an acceptable safety profile over the threeyear follow-up provided by the study. The most important aspect of the study is that patients were recruited from all other the world, and thus results are generalizable to the worldwide pediatric population. From a clinical point of view, latanoprost and other prostaglandin analogues are commonly used for the treatment of childhood glaucoma, so their good tolerability and efficacy are not surprising for the clinician.^1-3 What is unfortunately limited from this real world study is a safety analysis in patients affected by glaucoma at a younger age (i.e., < five years), even if other studies have demonstrated an excellent safety profile in pediatric glaucoma patients.³ Surprisingly, in spite of the good safety profile of latanoprost, the IOP was unchanged from baseline (mean change, 0.1 ± 4.48 mmHg). This could be due to the heterogeneity of the studied cohort.

These physiological parameters significantly vary over a 24-hour period with postural and diurnal variation unaccounted for in the current study

In contrast, in a recent prospective study, latanoprost was shown to be effective in a longterm follow-up (three-year) in selected patients affected by primary pediatric glaucoma who underwent a single surgical procedure.⁴ The efficacy of pharmacological treatment was inversely related to central corneal thickness at the time of surgery, and the age at the time of surgery. Similar to Younus et al., the safety was excellent and none of the patients withdrew due to adverse events.

I would like to applaud the authors for their important contribution to our knowledge of pediatric glaucoma and its treatment. Future research from this group will hopefully provide complete safety and efficacy profiles for latanoprost and other prostaglandin analogues in patients affected by pediatric glaucoma with longer term follow-up.

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