latanoprost and Keratitis

Benzalkonium chloride (BAK), the most commonly used preservative in topical ophthalmic solutions, has undergone considerable criticism in recent years, principally based on in vitro and in vivo studies. Relevance to the clinical setting has not been confirmed.. To determine whether administration of twice the amount of BAK was associated with an increased incidence of punctate keratitis in long-term, double-masked trials comparing latanoprost ophthalmic solution and vehicle with timolol ophthalmic solution in patients with glaucoma or ocular hypertension.. A meta-analysis of the double-masked phases of 7 prospective, controlled clinical trials compared the incidence of punctate keratitis among patients assigned to treatment with latanoprost or timolol. In all studies, the amount of BAK administered daily in the latanoprost arms was approximately twice the amount used in the timolol arms. All reports of punctate keratitis either as a finding or an adverse event were included. A fixed-effect model was used because the heterogeneity was small and not statistically significant. Sensitivity analyses were conducted. Funnel plots were provided to address potential publication bias.. Of the 1694 patients enrolled in the double-masked portion of the trials (latanoprost, n = 892; timolol, n = 802), the overall incidence of punctate keratitis was 6.3% (106/1694). The incidence in latanoprost-treated patients was 6.5% and in timolol-treated patients was 6.0%. The risk difference for punctate keratitis of latanoprost versus timolol was 0.005 (95% CI -0.011 to 0.020; p = 0.574), and the risk ratio of latanoprost versus timolol was 1.084 (95% CI 0.739 to 1.589; p = 0.680).. These results indicate that BAK does not produce significant corneal toxicity in the vast majority of patients with glaucoma or ocular hypertension at the concentrations used in these studies.

Topics: Benzalkonium Compounds; Humans; Keratitis; Latanoprost; Ophthalmic Solutions; Preservatives, Pharmaceutical; Prostaglandins F, Synthetic; Randomized Controlled Trials as Topic; Timolol

To assess the effect of switching 1 eye to topical travoprost 0.004% preserved with SofZia (TRAVATAN Z solution) in patients who had chronic superficial punctate keratitis (SPK) in both eyes treated with benzalkonium chloride-preserved latanoprost 0.005% (XALATAN).. This was a prospective, randomized, controlled, multicenter, open-label, comparative 3-month follow-up study. Patients with open-angle glaucoma or ocular hypertension who received XALATAN monotherapy for at least 3 months and had SPK in both eyes were enrolled at 9 facilities. For each patient, 1 eye was randomly selected and switched to TRAVATAN Z solution (T-group); the contralateral control eye was treated with XALATAN (X-group). SPK in 5 corneal regions, conjunctival hyperemia, tear breakup time (TBUT), and intraocular pressure (IOP) were examined in a masked manner at baseline, 1 month, and 3 months. Changes in SPK, hyperemia, TBUT, and IOP were compared within treatment groups and between treatment groups.. Fifty-six patients completed the study. The frequency of SPK significantly decreased from baseline in the T-group and the X-group at 1 and 3 months (T-group, P<0.001; X-group, P<0.05). In the T-group, SPK scores were significantly improved in 4 corneal regions, excluding the superior region, at 1 and 3 months (all P<0.05), whereas in the X-group, SPK scores were significantly improved only in the temporal region at 1 month and in the inferior region at 3 months (P<0.05 for both). The total SPK score at 1 and 3 months in the T-group was significantly lower compared with the score in the X-group (P=0.0023 and 0.0102, respectively). The SPK score for the superior and central corneal region at 3 months in the T-group was significantly lower compared with the score in the X-group (P=0.0212 and 0.022, respectively). There were no substantial intergroup or intragroup differences in changes from baseline for hyperemia scores, TBUT, or IOP reduction.. Switching therapy from benzalkonium chloride-preserved latanoprost to travoprost preserved with SofZia ameliorated chronic SPK. There were no clinically relevant changes in hyperemia, TBUT, or IOP.

Topics: Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Chronic Disease; Cornea; Dose-Response Relationship, Drug; Drug Substitution; Female; Follow-Up Studies; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Keratitis; Latanoprost; Male; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Preservatives, Pharmaceutical; Prospective Studies; Prostaglandins F, Synthetic; Tonometry, Ocular; Travoprost

We report an unusual case of presumed late-onset unilateral diffuse lamellar keratitis of uncertain etiology in a 23-year-old man who presented with elevated intraocular pressure following uneventful laser in situ keratomileusis (LASIK). After treatment with topical corticosteroid therapy, the condition progressed to interface fluid syndrome. Isolated pockets of fluid were clearly demonstrated at the level of the LASIK flap interface on slitlamp biomicroscopy and in Pentacam Scheimpflug images.

Topics: Adult; Body Fluids; Corneal Stroma; Diclofenac; Drug Therapy, Combination; Humans; Intraocular Pressure; Keratitis; Keratomileusis, Laser In Situ; Latanoprost; Male; Microscopy, Confocal; Ophthalmic Solutions; Prostaglandins F, Synthetic; Surgical Flaps; Syndrome; Visual Acuity

To report a case of poliosis arising from treatment with topical medications.. Interventional case report.. A 37-year-old man was treated for fungal endophthalmitis arising from Aspergillus fumigatus keratitis with penetrating keratoplasty, lensectomy and vitrectomy together with systemic and prolonged topical medications.. Recovery was complicated by retinal detachment, elevated intraocular pressure and bullous keratopathy. Unilateral poliosis developed eight months following keratoplasty and has persisted over 2(1)/(2) years.. Topical medications are implicated in causing the poliosis.

Topics: Adult; Antihypertensive Agents; Aspergillosis; Econazole; Endophthalmitis; Eye Infections, Fungal; Eyelashes; Hair Diseases; Humans; Intraocular Pressure; Keratitis; Keratoplasty, Penetrating; Latanoprost; Male; Pigmentation Disorders; Prostaglandins F, Synthetic

To evaluate the ocular factors contributing to keratoepitheliopathy in glaucoma patients treated with or without anti-glaucomatous eyedrops, and the influences of each anti-glaucomatous eyedrop to keratoepitheliopathy.. The presence and severity of keratoepitheliopathy was investigated in 193 eyes of 110 glaucoma patients. The ocular factors examined were the status of the lipid layer of the tear fluid as assessed by a specular reflection video-recording system, tear volume assessed by Schirmer's test, and tear film stability assessed by tear break-up time. The influences of combined anti-glaucomatous eyedrops and each anti-glaucomatous eyedrops to keratoepitheliopathy were investigated.. The overall occurrence of superficial punctate keratitis was 29.0%. Superficial punctate keratitis was more frequently observed in patients who used more than two anti-glaucomatous eyedrops (35.9%) than in those who used without (19.7%) and one (30.9%). Results of Schirmer's test and break-up time were worse in patients who used combined medication. The occurrence of superficial punctate keratitis in patients who used timolol (46.2%) was significantly more frequent than in those who used carteolol (4.2%). Severity of superficial punctate keratitis and break-up time in patients who used timolol were significantly worse than in those who used carteolol. There were no differences of keratoepitheliopathy and ocular factors between patients who used latanoprost and unoprostone.. The usage of multiple anti-glaucomatous eyedrops induces keratoepitheliopathy by reducing the tear volume and the tear film stability. Carteolol may be used more safely for corneal epithelium.

Topics: Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Carteolol; Dinoprost; Drug Therapy, Combination; Epithelium, Corneal; Female; Glaucoma, Open-Angle; Humans; Keratitis; Latanoprost; Male; Middle Aged; Ophthalmic Solutions; Prostaglandins F, Synthetic; Risk Factors; Sulfonamides; Tears; Thiophenes; Timolol