Use Of Prostaglandin Analogues Research Articles

Cross-sectional Associations of Medication and Supplement Use With Retinal Vascular Diameter in the Beaver Dam Eye Study

Retinal vessel diameters are being measured to examine their relationship with ocular and systemic disease and, in some studies, to calculate the risk of disease. Important factors that directly affect retinal vessel diameters, such as medication use, should be considered when estimating these associations. To quantify the association between selected medications and supplements and retinal vessel diameters. In a prospective cohort investigation, 4926 participants (aged 43-86 years at baseline) in the Beaver Dam Eye Study were evaluated every 5 years during 20 years of follow-up from 1988 to 2010. Central retinal arteriolar equivalent and central retinal venular equivalent measured from the Early Treatment Diabetic Retinopathy Study fundus photograph field 1. After Bonferroni correction, the use of any blood pressure medication (β = 0.75; P = .04), specifically calcium channel blockers (β = -1.02; P < .001), was significantly associated with wider central retinal arteriolar equivalent adjusting for refraction, photograph focus, age, systolic blood pressure, height, examination phase, educational level, smoking and drinking histories, and presence of diabetes mellitus and emphysema. Use of prostaglandin analogues was marginally associated with narrower central retinal arteriolar equivalent (β = -2.04; P = .09); β-blockers (β = -1.02; P = .10) and oral corticosteroids (β = 2.13; P = .07) were marginally associated with changes in the central retinal venular equivalent. Several medications are associated with central retinal arteriolar and venular equivalents. Prostaglandin analogues, calcium channel blockers, and oral corticosteroids have the largest relative effects. After Bonferroni correction was applied, the use of calcium channel blockers was most strongly associated with change in the central retinal arteriolar equivalent. The presence of factors that are associated with retinal vessel diameters should be considered when using retinal vessel diameter as an outcome or when using these measures to assess the risk of systemic or ocular disease.

Contralateral intraocular pressure lowering effect of prostaglandin analogues.

Background:Though the use of prostaglandin analogues (PGA) for reduction of intraocular pressure (IOP) has shown a marked increase, studies evaluating the contralateral effects of PGA are limited.Aims:To evaluate if PGA treatment in one eye has an effect on the IOP of the untreated fellow eye.Design:Retrospective study.Materials and Methods:Thirty patients of open-angle glaucoma with no previous antiglaucoma treatment underwent 24-hour diurnal IOP phasing. They subsequently were started on a uniocular trial with PGA, and had office diurnal IOP measurements 6 weeks later. Twenty-four hour diurnal consisted of 8 IOP readings over 24 hours and office diurnal consisted of 4 IOP readings between 8 AM and 6 PM at 3 hourly intervals.Statistical Analysis:IOPs of the fellow eye during the office diurnal were compared with IOPs at similar time points during the 24-hour diurnal using paired t-tests.Results:Mean (± standard deviation) IOP in the treated eye reduced (P < 0.001) from 17.17 ± 3.2 mm Hg at baseline to 13.7 ± 2.4 mm Hg at 6 weeks, while that in the untreated eye reduced from 16.4 ± 3.1 mm Hg to 14.8 ± 2.7 mm Hg (P = 0.01). The decrease in IOP in the untreated fellow eye was statistically significant at 8 AM (2.7 mm Hg, P = 0.003) and 11 AM (2.3 mm Hg, P = 0.01) but not so at 2 PM (1.2 mm Hg, P = 0.10) and 5 PM (0.9 mm Hg, P = 0.19). The amount of IOP reduction in the untreated eye was significantly associated with the magnitude of IOP reduction in the treated eye (β = 0.69, P = 0.008).Conclusion:Uniocular PGA treatment tends to reduce the IOP of the untreated fellow eye.

Skin Graft Hypertrichosis Associated With Prostaglandin Analog in the Treatment of Glaucoma

Prostaglandin analogs are commonly used in the treatment of glaucoma. They are a safe and effective treatment associated with few side effects. Common local side effects include conjunctival hyperemia, iris pigmentation, and eyelash hypertrichosis. The authors present a case of a patient using travoprost treatment for primary open-angle glaucoma, who underwent excision of a lower eyelid basal cell carcinoma and reconstruction with an upper eyelid tarsoconjunctival flap and overlying skin graft. The patient developed hypertrichosis of the skin graft attributable to prostaglandin analog use.

Impact of Combination Use of 0.004% Travoprost and 2% Pilocarpine on Matrix Metalloproteinases Synthesized by Rabbit Ciliary Muscle: a Pilot Study

To explore the impact of combination use of prostaglandin analogue and cholinergic agonists on main matrix metalloproteinases (MMPs) synthesized by albino rabbit ciliary muscle. Normal adult albino rabbits were divided into the control group, 2% pilocarpine group, 0.004% travoprost group and travoprost plus pilocarpine group. Two rabbits in the control group were executed after treated with normal saline for one day. Two rabbits were separately executed on the 7th, 14th and 24th day of the treatment in each drug treated group. In each subgroup ciliary muscle band of 4 eyes was taken and made into homogenate. The MMPs activities of 10 subgroups were assayed by zymography. Bands' intensity which represents the activity of MMPs was measured by the UltraViolet Illumination system. A bright band of MMP-1/2 was showed on each lane at the position corresponding to the molecular weight of 62 kD in the ciliary smooth muscles electrophoresis. When ion Zn and Ca was displaced by MMPs inhibitor EDTA, this bright band disappeared. Compared with the control group, MMP1/2 activity increased by 4.0%, 4.1% and 14.0% after 7, 14 and 24 days of pilocarpine treatment. Corresponding data was 23.2%, 61.7% and 111.5% in the travoprost group and 49.3%, 68.0% and 88.4% in the travoprost plus pilocarpine group. Pilocarpine has little effect on activity of MMP1/2. Travoprost can increase activity of MMP1/2 gradually. Activity of MMP1/2 is rapidly increased by pilocarpine combined with travoprost, but shows small change with the prolonged treatment.

A Cross-Sectional Survey of the Association between Bilateral Topical Prostaglandin Analogue Use and Ocular Adnexal Features

We studied the relation between prostaglandin analogue use and ocular adnexal features. We used a prospective, cross-sectional study involving 157 current, 15 past, and 171 never users of prostaglandin analogues. Patients 50 years of age or older and without conditions affecting ocular adnexal anatomy underwent glaucoma medication use history, external digital photography and systematic external adnexal exam. Two masked readers assessed the digital photos for upper lid dermatochalasis and lower lid steatoblepharon using a validated grading scheme. Another masked clinical examiner also assessed upper lid ptosis, levator muscle function, and inferior scleral show. We performed ordinal logistic regression analysis accounting for multiple covariates to assess the relation between prostaglandin analogue use and adnexal features. Multivariable analyses indicated there was a 230-fold increased risk of incremental involution of dermatochalasis (odds ratio (OR) = 2.30; 95% confidence interval (CI) 1.43–3.69; p = 5.44E-04) and a 249-fold increased risk of incremental loss of lower lid steatoblepharon (OR = 2.49; 95% CI, 1.54–4.03; p = 1.98E-04) associated with current prostaglandin analogue use (bimatoprost 0.03%, travoprost 0.005%, or latanoprost 0.004%) versus prostaglandin analogue never or past users. Upper lid ptosis (OR = 4.04; 95% CI, 2.43–6.72; p = 7.37E-08), levator dysfunction (OR = 7.51; 95% CI, 3.39–16.65; p = 6.74E-07) and lower lid retraction (OR = 2.60; 95% CI, 1.58–4.28; p = 1.72E-04) were highly associated with current prostaglandin analogue use versus prostaglandin analogue never or past users. The associations between prostaglandin analogue use and deepening of the upper lid sulci and between prostaglandin analogue use and loss of inferior periorbital fat are confirmed in this multivariable analysis. The associations between prostaglandin analogue use and levator muscle dysfunction and between prostaglandin analogue use and upper lid ptosis represent significant side effects that could impact visual function in glaucoma patients.

Conjunctival inflammation in patients under topical glaucoma treatment with indication to surgery

To compare the frequency of conjunctival HLA-DR expression (a surrogate marker for inflammation) in eyes treated with topical prostaglandin analogues versus eyes treated with other topical antiglaucomatous drugs. Patients diagnosed with primary open-angle glaucoma presenting indication for trabeculectomy were divided in groups according to the use or not of prostaglandin analogues. All subjects were treated with the maximum tolerated dose of antiglaucomatous drugs until the date of the surgery. At the beginning of the surgical procedure, a 5 x 5 mm biopsy of the bulbar conjunctiva was collected, incubated with monoclonal anti-HLA-DR antibody and processed for histological analysis. Of the 31 eyes included (31 patients), 25 were under topical prostaglandin analogues (Group 1) and six under other topical pharmacological agents (Group 2). Fourteen eyes of Group 1 (56%) and three of Group 2 (50 %) were positive for the inflammatory marker HLA-DR (P=1.0). The percentage of stained cells ranged from 15.49 to 48.09% (median: 27.61) in Group 1, and from 18.35 to 28 (median: 20.71) in Group 2, with no differences statistically significant (p=0.33). The use of prostaglandin analogues did not increase conjunctival expression of HLA-DR compared to other topical antiglaucomatous agents.

Topical Prostaglandin Analogues and Conjunctival Inflammation in Uveitic Glaucoma

Purpose: A pilot study to determine whether topical prostaglandin analogues alter the expression of conjunctival inflammatory markers in patients with uveitic glaucoma.Methods: 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.Results: 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.Conclusions: 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.

Baseline Factors Predictive of SLT Response: A Prospective Study.

Purpose. To study the response to Selective Laser Trabeculoplasty (SLT) according to baseline medical treatment, angle pigmentation, age, diagnosis (open-angle glaucoma or ocular hypertension), and baseline intraocular pressure (IOP). Methods. 74 eyes of 74 patients were enrolled in this study. Baseline characteristics were recorded for each patient. IOP in the treated and fellow eyes was measured at baseline, and 1 month, 6 months, and 12 months following SLT. IOP changes in the different groups were compared using two-way ANOVA and Pearson's correlation. Results. The mean age of our cohort was 71 ± 10 years. The mean baseline IOP was 21.5 ± 5 mmHg, and the mean change in IOP from baseline in the treated eye at one year was −4.67 ± 3.40 mmHg. Higher baseline IOP was highly correlated with greater absolute IOP decrease. Prostaglandin analogue use at baseline was shown to be associated with a statistically decreased IOP-lowering response following SLT when corrected for baseline IOP. No significant differences in IOP response were found when comparing groups stratified for age, angle pigmentation, phakic status, gender, or diagnosis. Discussion. The results of this study confirm the finding that higher baseline IOP is a predictor of greater IOP response following SLT, and that pretreatment with prostaglandin analogue therapy is associated with a decreased IOP-lowering response following SLT. The study is limited by the small number of eyes with data available for complete case analysis.

The Influence of Topical Prostaglandin Analogues in Inflammation After Selective Laser Trabeculoplasty Treatment

Reducing intraocular pressure (IOP) seems to be the only treatment that slows progression in glaucoma. The IOP can be decreased by pharmaceutical treatment, laser [selective laser trabeculoplasty (SLT)] treatment, or surgery. Prostaglandin analogues have been postulated to share action mechanisms with SLT and to possibly diminish the effects of SLT treatment. The aim of the current study was to investigate the effects of prostaglandin analogues in inflammation and IOP reduction after SLT treatment. Prospective nonrandomized study. One hundred and eighteen patients were included in the study. Glaucoma (open-angle or pseudoexfoliation glaucoma) patients who will be treated with SLT. Inflammation was measured with a laser flare meter (Kowa FM-500). Measurements were made before SLT and then 2 h, 1 week, and 1 month after SLT treatment. IOP was also checked at the same time intervals. The SLT treatment was performed over 90°. All patients were divided into two groups: those receiving prostaglandins analogues and those treated with nonprostaglandin analogues. Inflammation before and after SLT showed no significant difference between the groups at all the time intervals studied (t-test, before: P=0.16; 2 h: P=0.14; 1 week: P=0.12; and 1 month: P=0.36). IOP reduction showed no significant difference between the groups (t-test, P=0.31). SLT treatment effects do not seem to be influenced by the use of prostaglandin analogues.

Effect of prostaglandin analogues on tear proteomics and expression of cytokines and matrix metalloproteinases in the conjunctiva and cornea

The purpose of this work was to identify potential tear-film-based proteins and their effect on changes in the conjunctiva and cornea in eyes using prostaglandin (PG) analogues. Recruited subjects were individuals who had used PG for at least 1 year and comparison with eyes of normal controls and timolol using patients were done. Approximately 3–5 μL of tears were sampled from both eyes of each subject using glass microcapillaries. Proteomic analysis was done to compare the pooled tear samples from each group by Bradford assay and cytokine arrays. Impression cytology was used to gather mRNA from conjunctival epithelial cells, and target protein mRNA was quantified by PCR. Rabbits treated with PG were scarified, and changes in the corneal stroma were evaluated by immunohistochemical staining and western blot analysis. There were increased levels of IL-1β, IL-6, MMP-1, MMP-3, and MMP-9 and decreased levels of TIMP-1 and TIMP-2 in the tears of PG-treated patients. The mRNA of IL-1β, MMP-1, MMP-3, and MMP-9 was elevated and mRNA of TIMP-1 and TIMP-2 was decreased in the conjunctival epithelial cells. Rabbits treated with PG showed corneal thinning with decreased collagen type I expression. The protein of MMP-1 and MMP-9 was elevated and protein of TIMP-1 was decreased in the rabbit cornea by western blot analysis. Immunohistochemical staining showed elevated expression of MMP-1 and MMP-9 and the decreased expression of TIMP-1 in the corneal stroma. The topical use of PG analogues results in an altered balance between MMPs and TIMPs, which may be triggered by inflammatory cytokines. This results in an increase of matrix degradation and decrease of stromal collagens in the cornea by PG treatments.

Topical Antiglaucoma Treatment With Prostaglandin Analogues May Precipitate Meibomian Gland Disease

The popular use of topical prostaglandin analogues (TPAs) in glaucoma patients has a well-documented association with changes in number, length, thickness, and growth pattern of eyelashes. A link between meibomian gland disease and seborrheic blepharitis resulting from topical administration of prostaglandin analogues has not been made to the authors' knowledge. A retrospective study of 43 patients presenting for incision and curettage of chalazion to the operating theatre over a 2-year period was performed. The patients' histories were reviewed to establish whether they were using TPAs for glaucoma at the time of surgery. Eight patients (19%) were using TPAs at the time of surgery. No patient had a history of eyelid margin disease before the commencement of TPAs. The exact pathogenesis of how meibomian gland disease is linked to TPA use is unclear. We postulate that the topical application of prostaglandin analogues may contribute to the formation of chalazion by acting directly to stimulate meibomian gland secretion. The authors present the findings of a preliminary case series showing a higher-than-expected incidence of patients using TPAs requiring surgical intervention for chalazion.

Randomized crossover study of latanoprost and travoprost in eyes with open-angle glaucoma

To compare the intraocular pressure (IOP)-lowering effects of 0.005% latanoprost to that of 0.004% travoprost in eyes with open-angle glaucoma (OAG). Forty-two patients with OAG who received either latanoprost or travoprost every evening for 12 weeks, and then switched to the other medication for another 12 weeks. The IOP measurements were made with a Goldmann applanation tonometer (GAT) at the baseline, and at 1, 3, 4, and 6 months after the treatment. The IOP at the untreated baseline and at the end of each treatment period was measured at 10:00, 12:00, and 16:00 hours. The central corneal thickness (CCT) was measured at each visit using an ultrasonic pachymeter. The mean baseline IOP was 13.9 ± 2.5 mmHg, and the CCT was 536.7 ± 30.5 μm. Latanoprost reduced the IOP by 2.5 ± 1.7 mmHg and travoprost by 2.6 ± 1.5 mmHg from the baseline (p = 0.6807). The CCT decreased significantly to 531.9 ± 30.3 at 3 months (p = 0.0160) and to 529.4 ± 30.5 μm at 6 months (p = 0.0002) after the therapy. The decrease was significantly greater in eyes after travoprost (p = 0.0049). Travoprost has similar effect as latanoprost in reducing the IOP in glaucoma patients with relatively low IOPs. The use of prostaglandin analogs can decrease the CCT, and this change should be considered when the IOPs obtained by GAT are analyzed.

Trends in glaucoma medication expenditure: Medical Expenditure Panel Survey 2001-2006.

To study trends of glaucoma medication expenditure from 2001 to 2006 using a nationally representative sample of US adults. We analyzed glaucoma medication expenditure trends among participants of the 2001-2006 Medical Expenditure Panel Survey, a subsample of the National Health Interview Survey, which is a continuous multipurpose, multistage area probability survey of the US civilian noninstitutionalized population. After adjusting for survey design and inflation using the 2009 inflation index, data from 1404 participants 18 years and older using glaucoma medication were analyzed. Mean annual glaucoma medication expenditure per subject increased from $445 in 2001 to $557 in 2006 (slope = 20.8; P < .001). Subgroup analysis showed expenditure increased significantly in women (P = .02), those with public-only insurance (P < .001), and those with less than a high school education (P < .008). Over the survey period, a significant decrease in expenditures on β-blockers (P = .048) and significant increases in expenditures on prostaglandin analogs (P = .01) and α-agonists (P = .01) were found. Factors associated with increasing glaucoma medication expenditure trends include the increasing use of prostaglandin analogs, changes in insurance coverage, and possibly more aggressive glaucoma treatment. The findings are pertinent to the development of cost-effective strategies that optimize treatment and reduce expenditures.

Misoprostol-induced pulmonary edema in a parturient with postpartum cardiomyopathy

Misoprostol, a synthetic prostaglandin E1 (PGE1) analogue, although not the first-line drug in the management of postpartum hemorrhage, is frequently used for this purpose due to its safety profile and cost-effectiveness. Cardio-pulmonary complications have been previously reported with use of prostaglandin analogues but not with misoprostol. We describe a case of pulmonary edema after the use of vaginal misoprostol for treatment of postpartum vaginal bleed in an otherwise healthy asymptomatic patient, who was later diagnosed as a case of peripartum cardiomyopathy.

EFFICACY OF PROSTAGLANDIN F2a AND ITS ANALOGS IN ENHANCING REPRODUCTIVE EFFICIENCY OF DOE RABBITS

The efficacy of prostaglandin F2a. (PGF2a.) and two analogs for inducing parturition in does to increase long-term rabbitry efficiency was studied. For the two-year trial, 40 single doe cages were used as experimental units. There were four treatments - does injected on day 29 of gestation with 5 mg PGF2a. 35 µg fenprostalene, 35 µg cloprostenol, or 1 mi saline as a control. Attempts to remate does began at 7 days post partum and were continuad daily until the doe accepted service. Ali does housed in a particular cage during the trial received the same treatment. The model included the fixed main effects of treatment, year, and season, with doe within treatment and residual error as random effects. The linear effect of parity was included as a covariate for those traits where it was significant (number of kits weaned and nest score). Doe repeatability accounted for significant varlation in litter birth weight (16.9±5.1 %), total kits born per litter (22.5±5.1%), kits born live per litter (19.5±5.0%), nest score (24.4±5.2%), and kits weaned per litter (14.6±4.8%). The 31.9±0.1 d gestation seen in the Jul-Sep season was graatar (P&lt;0.05) than tha other saasons (31.2±0.1 to 31.6±0.1 d). Litter birth weight was greater (P&lt;0.05) in Jan-Mar (338±19 g) than in Jul-Sep. (279±19 g) and followed a pattern similar to the number of kits born. At 63.5 d, tha kindling interval in the Oct.-Dec. period was longar than the othar seasons (P&lt;0.01). During tha same period, the conception rate was lowar (P&lt;0.01) as indicated by the higher number of servicas per litter (2.3±0.1 vs. 1.7±0.1, 1.6±0.1 and 1.6±0.1 for Jan.-Mar., Apr.-Jun. and Jul.-Sap., respectively.) Gestation length for saline treated does was 31.9±0.2 d vs. 31.4±0.4, 31.1±0.3 and 31.3±0.2 for the fenprostalene, cloprostenol and PGF2a. traated does, respactively (P&lt;0.01). Fenprostalene and cloprostenol treated does kindled 7.3±0.5 and 7.2±0.5 kits per litter while PGF2a. treated does had only 5.8±0.5 kits per litter (P&lt;0.01). Fenprostalene treatad does had larger (P&lt;0.05) litters born live (6.0±0.5) than PGF2a. treated does (4.8±0.5). At 330±21 g, the litter birth weight of salina treatad does was greater than PGF2a. treated does (285±20) (P&lt;0.05). Treatment had no effect on the quality of the nest constructed and little effect on subsequent reproductiva performance, although the fenprostalene treated does showad the least degrae of lordosis (P&lt;0.05). Treatment with PGF2a. and the two analogs did not significantly shorten the kindling interval nor affect the number of services requirad for each litter. There were no differences among long-term responses to PGF2a. and its synthetic analogs nor any effect on conception rate. However, the differences in litter size born and born aliva indicate sorne differences may exist. Using our procedures, and breeding by natural service, routine use of prostaglandins or prostaglandin analogs did not improve reproductive efficiency in maat rabbits.

The Effect of PGF2α-Induction of Estrus on Pregnancy Rates in Mares

In mares, the onset of estrus is routinely induced after a luteolytic dose of a prostaglandin F2alpha analogue. Mares in diestrus with a mature, functional corpus luteum will respond by coming into estrus 3 to 4 days after induction 1 . Shortening the interestrous interval in mares has an important economic impact on the equine breeding industry. Because the breeding season of the mare is short, timing of insemination and appropriate coordination of endocrine events is critical to pregnancy success and ultimate foaling rates. Several recent studies have reported that the use of prostaglandin analogues is associated with lower pregnancy rates. In this study the induction of estrus with cloprostonol (125-250 ug IM) did not affect pregnancy rates in mares that have ovulatory cycles (n = 461).

A review of preserved and preservative-free prostaglandin analogues for the treatment of open-angle glaucoma and ocular hypertension

Glaucoma affects an increasing number of people worldwide and is the second leading cause of blindness. The aim of antiglaucoma therapy is to maintain a patient's visual function and quality of life. Prostaglandin analogues are first-line topical antiglaucoma therapy. They are effective at lowering intraocular pressure (IOP) and are generally well tolerated, with fewer systemic adverse events compared with the other classes. However, the use of prostaglandin analogues can be associated with ocular adverse effects, such as stinging/burning sensation, dry eyes, iris and periocular hyperpigmentation, and eye lash growth, which can affect patient compliance. Preservatives used in antiglaucoma preparations can have dose-dependent toxic effects, which contribute to adverse effects. The development of preservative-free preparations may reduce such adverse effects and therefore improve patient compliance. Tafluprost is a prostaglandin analogue in a preservative-free formulation that was recently approved for the reduction of elevated IOP in open-angle glaucoma and ocular hypertension.

Immunohistochemical Expression of HLA-DR in the Conjunctiva of Patients Under Topical Prostaglandin Analogs Treatment

Subclinical inflammation may be observed in patients using topical antiglaucomatous drugs. The objective of this study was to investigate inflammation in conjunctiva of glaucoma patients using prostaglandin analogs, by the detection of an immunogenetic marker (HLA-DR) and compare the effect of 3 different drugs: latanoprost, bimatoprost, and travoprost in the induction of this inflammation. Thirty-three patients with primary open-angle glaucoma were evaluated without and with prostaglandin analogs topical therapy. Imprints of conjunctival cells were obtained, fixed on glass slides, and prepared for immunohistochemical analysis. Before the use of prostaglandin analogs, 4 of the 33 patients evaluated presented expression of HLA-DR in the conjunctiva (mild). After 1 month on prostaglandin analog treatment, all but 1 patient presented HLA-DR staining. HLA-DR expression of these 32 patients was scored as mild (19 patients), medium (11 patients), or intense (2 patients). The differences were statistically significant both when the presence and the increased expression of HLA-DR were considered (P<0.001). When the 3 different groups were analyzed (latanoprost, bimatoprost, and travoprost) no statistically significant difference was found (P=0.27). The use of prostaglandin analogs eye drops provokes a subclinical inflammatory reaction, observed by HLA-DR expression, even after a short period of treatment, independently of the class of the prostaglandin analogs used.

Determinants of Adherence to Glaucoma Medical Therapy in a Long-term Patient Population

Estimate patient adherence to glaucoma medications and identify potential determinants of nonadherence. Descriptive study. Two hundred patients with open angle glaucoma, ocular hypertension, or glaucoma suspects were interviewed regarding their glaucoma and its treatment and their charts were reviewed. Their ophthalmologist completed a brief assessment form. Drug utilization data were extracted from the provincial drug program database. Patients were defined as adherent if they filled at least 75% of the prescribed medication necessary for their treatment. Data were available for 181 patients. About 62.9% were female and the mean age (+/-SD) was 75.1+/-8.8 years. The mean number of years of glaucoma treatment was 10.7+/-9.3. Self-reported treatment adherence was 88.3%. On the basis of the drug database, the proportion of patients who were adherent to treatment was 71.8%. According to physicians, 74.6% of patients were adherent. Among patients considered by physicians as nonadherent, 71.1% (32/45) were adherent and among patients predicted as adherent, 72.1% (98/136) were adherent. There was no significant difference in adherence according to age, sex, education, and income. However, patients using fewer agents (P=0.041), who were widowed (P=0.041), or who lived alone (P=0.042) were more adherent. Patients using prostaglandins analogs or beta-blockers were more adherent than those using carbonic anhydrase inhibitors (P<0.05). Fewer medications, use of prostaglandin analogs or beta-blockers, living alone, and being widowed were significantly associated with adherence. Physicians were unable to significantly predict which patients are adherent.

Topical prostaglandin analogues do not affect selective laser trabeculoplasty outcomes

To investigate the effect of topical prostaglandin analogue use on the efficacy of selective laser trabeculoplasty (SLT) intraocular pressure (IOP) lowering in patients with open-angle glaucoma. This retrospective study included 123 consecutive patients who underwent 180 degrees SLT for the first time. Eyes were grouped into those that received prostaglandin analogues before and after SLT (n=74) and those that did not (n=49). The main outcome measure was IOP lowering after SLT. Success was defined as > or =20% reduction in IOP without further glaucoma intervention. There was no significant difference in IOP lowering at 6 months post-laser between the prostaglandin and non-prostaglandin groups (3.9+/-4.8 vs 4.6+/-3.6 mm Hg, P=0.43). Long-term SLT success rates were also not significantly different between the treatment groups (Kaplan-Meier survival analysis, P=0.68). IOP lowering at 6 months was similar in eyes that received no glaucoma medications, monotherapy with or without a prostaglandin analogue, or combination therapy with or without prostaglandin analogues (P=0.81). Logistic regression analysis showed that various patient characteristics including age, sex, type of glaucoma, previous glaucoma surgery, and other glaucoma risk factors did not predict a successful SLT outcome. However, higher pre-operative IOP was found to predict SLT success (odds ratio=1.12, 95% CI=1.02-1.24, P=0.02). The IOP lowering efficacy of SLT is not influenced by the use of topical prostaglandin analogues.