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Editors Selection IGR 22-2
Medical Treatment: Effects of Prostaglandins on Eyelids
Comment by Cedric Schweitzer on:
94608 Recovery of deepening of the upper eyelid sulcus after switching from prostaglandin FP receptor agonists to EP2 receptor agonist: a 3-month prospective analysis, Sakata R; Fujishiro T; Saito H et al., Japanese Journal of Ophthalmology, 2021; 65: 591-597
The authors report the results of a single-centre, prospective, non-comparative, observational study assessing improvement in the deepening of the upper eyelid sulcus (DUES) of 23 glaucoma patients undergoing a switch from topical prostaglandin FP receptor agonists to topical prostaglandin EP2 receptor agonists after three months of follow-up. Twenty-three eyes of 23 open-angle glaucoma patients complaining for DUES induced by topical medications were included. Patients were asked to switch to EP2 receptor agonists treatment without any wash-out period and the eye with the more severe DUES was analysed. Patients could also have concomitant topical glaucoma medications and DUES was assessed using photography before the switch, and at one month and three months after the switch. Noteworthy, three independent investigators masked to the chronology of photographies evaluated changes at two time points and reached a consensus in case of disagreement.
An improvement in deepening of the upper eyelid sulcus was observed for twelve eyes at one month and sixteen eyes at three months
An improvement in DUES was observed for twelve eyes at one month and sixteen eyes at three months. A higher number of concomitant topical medication was associated with a significant improvement in DUES at three months. Finally, mean IOP measured at each post-switch follow-up visit was not significantly different with mean IOP measured before the switch.
The authors pointed out that FP receptor agonists may decrease periorbital fat production and that a switch to a EP2 receptor agonists could alleviate DUES with a comparable IOP lowering effect.
Despite authors' findings and the rational of their study hypothesis, improvement in DUES following the switch to EP2 receptor agonists would need further investigations.
The follow-up after the switch was also likely too short for a full assessment of DUES changes
Indeed, the sample size was small and the analysis may lack of statistical power particularly for IOP measurements comparison as well as for factors associated with DUES changes. Additionally, the relationship between the onset of DUES and the use of FP receptor agonists was not documented in the population sample, and the follow-up after the switch was also likely too short for a full assessment of DUES changes. Finally, the study design may not have been the most appropriate to demonstrate the authors' hypothesis. For instance, an intra-individual comparison with one eye of each included patient allocated to a switch to EP2 receptor agonists and the fellow eye continuing FP receptor agonists would have been worth for demonstrating DUES changes.
In conclusion, incidence and severity of DUES respectively induced either by FP or EP2 receptor agonists would need to be analysed in a large prospective comparative study with a longer follow-up for providing accurate information to patients and ophthalmologists.
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