latanoprost and Blindness

Glaucoma is a leading cause of the global prevalence of irreversible blindness. The pathogenesis of glaucoma is not entirely known, but the major risk factors include advancing age, genetic predisposition, and increased intraocular pressure (IOP). The only evidence-based treatment is a lowering of IOP through the use of eye drops, laser procedures, or surgical interventions. Although laser treatment is gaining recognition as a first-choice treatment option, the most common approach for managing glaucoma is IOP-lowering eye drops. A major challenge in the treatment is the occurrence of adverse events and poor adherence. In this context, the ocular surface is an area of great concern, as most glaucoma patients have dry eye disease (DED), which is largely caused by eye drops. Preservation with benzalkonium chloride (BAK) is a controversial topic due to its potential role as a significant cause of DED. A systematic review and meta-analyses investigate potential differences in efficacy and safety between BAK-preserved and BAK-free anti-glaucomatous eye drops (I). Many of the included studies report on ocular surface damage caused by the application of BAK-preserved eye drops. However, the meta-analyses addressing hyperemia, number of ocular adverse events, and tear break-up time did not identify any significant differences. The latter is likely due to varying measurement methods, different endpoints, and study durations. It is, therefore, possible that the large variations between the studies conceal differences in the safety profiles. The efficacy meta-analysis finds that there are no differences in the IOP-lowering effect between BAK-preserved and BAK-free eye drops, indicating that BAK is not necessary for the effectiveness of eye drops. To promote more homogeneous choices of endpoints and methods when evaluating BAK-preserved and BAK-free glaucoma treatments, a Delphi consensus statement was performed. In this study, glaucoma experts and ocular surface disease experts reached consensus on the key factors to consider when designing such studies (II). The hope is to have more studies with comparable endpoints that can systematically show the potentially adverse effects of BAK. The preclinical studies in the current Ph.D. research focus on conjunctival goblet cells (GCs). GCs are important for the ocular surface because they release the mucin MUC5AC, which is an essential component of the inner layer of the tear film. BAK preservation may damage the GCs and r. Danish Summary: Glaukom (grøn staer) er en af de hyppigste årsager til blindhed på verdensplan. Årsagen til glaukom kendes ikke, men de vaesentligste risikofaktorer er alder, genetik og forhøjet intraokulaert tryk. Den eneste evidensbaserede behandling er saenkning af øjentrykket med enten øjendråber, laser eller kirurgi. Omend laserbehandling er blevet tiltagende anerkendt som førstevalgsbehandling, er øjendråber den mest udbredte behandlingsform. Da øjendråber mod glaukom kan medføre vaesentlige bivirkninger, er det en stor udfordring, at patienter med glaukom ikke bruger deres øjendråber korrekt. I denne sammenhaeng er øjenoverfladen et område, der vaekker bekymring, da langt de fleste glaukompatienter lider af øjenoverfladesygdom, som overvejende skyldes øjendråbebehandling. Konservering med benzalkoniumklorid (BAK) er kontroversiel, da BAK menes at vaere en vaesentlig årsag til øjenoverfladesygdom. Et systematisk review og metaanalyser undersøger forskelle i effekt og bivirkningsprofil mellem BAK-konserverede og BAK-frie øjendråber (I). Flere studier rapporterer om skade på øjets overflade ved brug af BAK-konserverede øjendråber. Dog findes der ikke forskelle i metaanalyserne, der undersøger hyperaemi, antal lokale bivirkninger og tåreopbrydningstid. De inkluderede studier har meget varierende outcomes, varighed og målemetoder. Det er derfor muligt, at de store variationer studierne imellem maskerer BAK's egentlige toksiske effekt. I metaanalysen, der undersøger dråbernes tryksaenkende effekt, findes der ingen forskel mellem BAK-konserverede og BAK-frie øjendråber, hvilket indikerer, at BAK ikke er nødvendig for dråbernes tryksaenkende effekt. For at bane vejen for mere ensartede valg af end points og metoder i kliniske forsøg, der undersøger BAK-konserverede og BAK-frie antiglaukomatøse øjendråber, er der lavet et Delphi konsensus studie (II). I studiet er eksperter i glaukom og overfladesygdom blevet enige om de vigtigste elementer, der bør inkluderes, når sådanne kliniske studier designes. Håbet er at øge maengden af studier med sammenlignelige end points og metoder som systematisk kan vise BAK's potentielt uhensigtsmaessige effekt på øjendråbers bivirkningsprofil. De praekliniske studier i den foreliggende afhandling fokuserer på de konjunktivale baegerceller, da baegercellerne er vigtige for øjets overflade. Baegerceller frigiver mucinet MUC5AC, som er en vigtig bestanddel i tårefilmens inderste lag. BAK-konservering kan beskadige baegercellerne

Topics: Antihypertensive Agents; Benzalkonium Compounds; Blindness; Conjunctiva; Glaucoma; Goblet Cells; Humans; Intraocular Pressure; Latanoprost; Ophthalmic Solutions; Preservatives, Pharmaceutical; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Travoprost

Topics: Administration, Ophthalmic; Antiviral Agents; Blindness; Drug Therapy, Combination; Female; Follow-Up Studies; Herpesvirus 1, Human; Humans; Incidence; Keratitis, Herpetic; Latanoprost; Male; Monitoring, Physiologic; Neuroprotective Agents; Prostaglandins F, Synthetic; Risk Assessment; Severity of Illness Index; Time Factors

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.

Topics: Blindness; Glaucoma; Glaucoma, Open-Angle; Humans; Hypersensitivity; Latanoprost; Ocular Hypertension; Preservatives, Pharmaceutical; Prostaglandins F; Prostaglandins F, Synthetic; Prostaglandins, Synthetic

Topics: Abscess; Adult; Anti-Bacterial Agents; Blepharoplasty; Blindness; Brimonidine Tartrate; Cavernous Sinus Thrombosis; Cellulitis; Clindamycin; Combined Modality Therapy; Decompression, Surgical; Dexamethasone; Drainage; Emergencies; Exophthalmos; Female; Gentamicins; Humans; Latanoprost; Nerve Compression Syndromes; Occupational Exposure; Optic Nerve Diseases; Orbital Diseases; Penicillins; Prostaglandins F, Synthetic; Quinoxalines; Streptococcal Infections; Streptococcus pyogenes; Surgical Wound Infection; Teaching; Timolol; Vancomycin; Vision Disorders

To compare the effects of topical 0.005% latanoprost (L) vs combined 0.005% latanoprost and 1% atropine (LA) on control of postoperative ocular hypertension (POH), development of posterior synechiae formation, pupil size, and blindness after phacoemulsification surgery in dogs.. Dogs with postoperative ocular hypertension were included in the study: L-group, latanoprost (eight dogs, 14 eyes) and LA-group, latanoprost and atropine (nine dogs, 15 eyes).. Complete ophthalmic examinations including tonometry were performed at 1, 7, and 21 days following phacoemulsification.. No significant differences were found between the measured intraocular pressure (IOP) at days 1 and 7 postphacoemulsification surgery in the L-group and the LA-group (P = 0.26 [14.12 ± 1.76 mmHg vs 16.96 ± 1.68 mmHg] and P = 0.71 [15.45 ± 1.43 mmHg vs 16.20 ± 1.36 mmHg], respectively). No significant differences were found between pupil sizes at day 7 for the two groups (P = 0.25 [13.83% vs 24.77%]). No significant differences were found between odds of posterior synechiae formation at day 21 (P = 0.92) with a probability ± SE for L-group vs LA-group at 0.27 ± 0.14 vs 0.25 ± 0.13. No significant differences were found in odds of postoperative blindness between groups (P = 0.58) with a probability ± SE of 0.21 ± 0.11 vs 0.13 ± 0.09, respectively for L and LA.. Combined topical latanoprost and atropine in dogs maintains normal postoperative IOPs but does not seem to cause increased mydriasis compared to latanoprost alone.

Topics: Animals; Atropine; Blindness; Cataract; Dog Diseases; Dogs; Drug Therapy, Combination; Female; Latanoprost; Lens Implantation, Intraocular; Male; Ocular Hypertension; Ophthalmic Solutions; Phacoemulsification; Postoperative Complications; Retrospective Studies

To determine the cost-effectiveness of ocular hypertension (OH) treatment initiated with latanoprost compared to timolol.. Two strategies for OH therapy are modelled, (1) 'starting with timolol' and (2) 'starting with latanoprost'. Therapy can be maintained or changed dependent on the achieved intraocular pressure (IOP) and side-effects. Adjustments of therapy to reach a target pressure involve monotherapy, combination therapy and laser. Four drugs are used: latanoprost, timolol, brimonidine and dorzolamide. Once the adjustments of therapy are completed, lifelong follow-up with IOP-dependent conversion to glaucoma and progression to blindness are modelled. Direct medical costs are assigned. The IOP-lowering effect of drugs is based on meta-analyses and applied by Monte Carlo simulation to a hypothetical cohort of patients with OH. The characteristics of the cohort, including the initial IOP distribution, are based on data of 1000 patients.. The IOP decreased from 25,4 mm Hg (mean) to 16.7 (±0.017) mm Hg (strategy 1) and to 16.5 (±0.013) mm Hg (strategy 2). Costs per patient within 15 months of therapy were € 367 and € 469, respectively. Lifetime blindness and costs were 0.0334 years and € 3,514 (strategy 1) and 0.0318 years and € 4,397 (strategy 2). Incremental costs per year of vision saved for strategy (2) in comparison with strategy (1) amount to, given the uncertainties in the model, approximately € 537,000.. For saving 1 year of vision, high costs are needed when OH therapy is initiated with latanoprost compared to timolol, when the cost price of latanoprost remains high.

Topics: Adult; Aged; Aged, 80 and over; Aging; Antihypertensive Agents; Blindness; Cost-Benefit Analysis; Decision Trees; Drug Costs; Female; Health Care Costs; Humans; Intraocular Pressure; Latanoprost; Male; Markov Chains; Middle Aged; Models, Theoretical; Ocular Hypertension; Prostaglandins F, Synthetic; Timolol; Tonometry, Ocular

To assess the impact of 2 strategies for initiating therapy in ocular hypertension (OH) on drug use, intraocular pressure (IOP), and blindness caused by glaucoma.. Using a simulation model, initiating therapy with timolol (strategy 1) and with latanoprost (strategy 2) was simulated for a hypothetic cohort of ocular hypertension patients with an initial IOP distribution (data of 1000 patients). Adjustment of therapy within 15 months and a subsequent lifelong follow-up, with an IOP dependent conversion to glaucoma, were modeled. The IOP lowering effect of medication (based on a meta-analysis) was applied by Monte Carlo simulation. Therapy could be maintained or changed, depending on the achieved IOP and side effects. Four drugs (latanoprost, timolol, brimonidine, dorzolamide) were used as monotherapy or in combination. Glaucoma conversion rate was based on literature.. Treatment goal was achieved in both strategies in 90% by monotherapy. This was 60% for patients with initial IOP's of 30 mm Hg. The originally prescribed medication was maintained in 66% (1) and in 77% (2). IOP decreased with approximately 34%, from 25.4 mm Hg (mean) to 16.7 mm Hg (1) and to 16.5 mm Hg (2) Blindness per person within 18.7 years of life expectancy was 0.0923 years (1) and 0.0870 years (2), which corresponds to approximately 1 month. The difference between strategies was 2 days spent in blindness per patient.. The difference in clinical effects of the strategies is small. This is largely owing to the key concept of a target pressure, which underlies both strategies.

Topics: Adult; Antihypertensive Agents; Blindness; Brimonidine Tartrate; Decision Trees; Disease Progression; Drug Therapy, Combination; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Markov Chains; Middle Aged; Models, Biological; Monte Carlo Method; Ocular Hypertension; Prostaglandins F, Synthetic; Quinoxalines; Risk Assessment; Sulfonamides; Thiophenes; Timolol