latanoprost and Optic-Nerve-Diseases

To evaluate the intraocular pressure (IOP)-lowering effects of adjunctive medications when added to 0.005% latanoprost taken once daily.. Pertinent publications were identified through systematic searches of PubMed, Embase, and the Cochrane Controlled Trials Register. Randomized clinical trials with over 85% of patients presenting with primary open-angle glaucoma or ocular hypertension who were treated with the combination treatment of latanoprost were selected. The pooled additional IOP-lowering effects at 1-3 months after a run-in phase of at least 2 weeks on 0.005% latanoprost once daily were calculated using the random effects model.. Nine randomized clinical trials were included. The mean pooled IOP reductions were 3.3 mm Hg (95% CI: 2.1-4.5) at trough and 4.4 mm Hg (95% CI: 3.4-5.4) at peak when adding 0.5% timolol once daily, 2.6 mm Hg (95% CI: 1.9-3.3) at trough and 3.8 mm Hg (95% CI: 2.5-5.2) at peak when adding 0.1/0.15% brimonidine twice daily, 2.6 mm Hg (95% CI: 1.7-3.4) at trough and 3.1 mm Hg (95% CI: 2.6-3.6) at peak when adding 2% dorzolamide twice daily, 2.4 mm Hg (95% CI: 2.0 -2.8) at trough and 2.7 mm Hg (95% CI: 2.2-3.2) at peak when adding 0.5% timolol twice daily, and 2.8 mm Hg (95% CI: 1.5-4.1) at trough and 1.8 mm Hg (95% CI: 1.2-2.3) at peak when adding 1% brinzolamide twice daily.. The addition of brimonidine, dorzolamide, timolol, or brinzolamide can further lower IOP in eyes being treated with latanoprost. Timolol 0.5% once daily might be the most effective adjunctive medication.

Topics: Aged; Antihypertensive Agents; Brimonidine Tartrate; Databases, Factual; Drug Therapy, Combination; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Optic Nerve Diseases; Prostaglandins F, Synthetic; Quinoxalines; Sulfonamides; Thiazines; Thiophenes; Timolol

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 investigate the relationship between drainage angle configuration with untreated intraocular pressure (IOP) and optic disc cupping in subjects with chronic angle-closure glaucoma (CACG).. Prospective, observational study.. Two hundred seventy-five Asian subjects with CACG who participated in a randomized controlled trial that investigated the IOP-reducing effect of latanoprost and timolol.. Chronic angle-closure glaucoma was defined as the presence of glaucomatous optic neuropathy (with or without a visual field defect), an anterior chamber angle in which the pigmented trabecular meshwork was not visible for at least 180 degrees on gonioscopy, and evidence of peripheral anterior synechiae (PAS) in association with elevated IOP of 21 mmHg or more. Static and dynamic gonioscopy were performed, the angles were graded in each quadrant according to the Shaffer scheme, and the number of clock hours of PAS was recorded. The untreated IOP and vertical cup-to-disc ratio were correlated with mean angle width and extent of PAS.. Mean angle width, clock hours of PAS, IOP, and vertical cup-to-disc ratio.. Most subjects were female (75%), and the mean age was 62.9+/-9.4 years. The mean angle width was 0.77+/-0.53 and the mean number of clock hours of PAS was 4.77+/-3.2 hours. Untreated IOP correlated with angle width (r = -0.23; P<0.001) and clock hours of PAS (r = 0.22; P<0.001). Vertical cup-to-disc ratio also correlated with angle width (r = -0.17; P = 0.004) and PAS (r = 0.28; P<0.001). Performing a multiple linear regression using baseline IOP as the outcome variable with age, gender, clock hours of PAS, and angle width as predictors, there was a 0.39-mmHg (95% confidence interval, 0.15-0.63) increase in baseline untreated IOP for each unit increase in clock hours of PAS (P = 0.002).. In subjects with CACG, the extent of PAS and a narrower width of the drainage angle were associated with higher untreated IOP and a larger vertical cup-to-disc ratio.

Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Antihypertensive Agents; Aqueous Humor; Chronic Disease; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Optic Disk; Optic Nerve Diseases; Prospective Studies; Prostaglandins F, Synthetic; Timolol; Trabecular Meshwork

To evaluate and compare the effects of latanoprost 0.005% once daily and brimonidine tartrate 0.2% twice daily in patients with normal-tension glaucoma (NTG).. A randomized, open-label, crossover study.. Twenty-eight NTG patients with progressive visual field defects/optic disc excavation, new disc hemorrhage, or field defects that threatened fixation.. Patients were randomly allocated to one of two groups. Patients in group 1 were treated with latanoprost, lubricant, and brimonidine for 4 weeks each, whereas patients in group 2 were treated with brimonidine, lubricant, and latanoprost for 4 weeks each.. Intraocular pressure (IOP), pulse rate, and blood pressure were measured at 8 am, 12 noon, and 4 pm after each 4-week treatment. Ocular perfusion pressure (OPP) was calculated.. Latanoprost and brimonidine reduced the average IOP by 3.6 +/- 1.9 mmHg (P < 0.001) and 2.5 +/- 1.3 mmHg (P < 0.001), respectively, with a significant difference between the two regimens (P = 0.009). Both drugs significantly reduced IOP at each time point. Latanoprost decreased IOP significantly more than did brimonidine at 8 am (11.7 +/- 2.2 mmHg vs. 13.7 +/- 2.1 mmHg, P = 0.004) and 4 pm (11.4 +/- 2.1 mmHg vs. 13.2 +/- 2.9 mmHg, P = 0.004), but IOP was equal between the two agents at 12 noon (11.5 +/- 2.6 mmHg vs. 11.5 +/- 2.3 mmHg, P = 0.967). IOP was maintained at 12 mmHg or lower in 18 (66.7%) of 27 patients after treatment with latanoprost and in 9 (33.3%) of 27 patients after treatment with brimonidine. Latanoprost monotherapy reduced IOP by 30% in 8 patients (29.6%), but brimonidine monotherapy did not reduce IOP by that much in any of the patients. OPP increased after latanoprost treatment (P < 0.001) but did not increase after brimonidine treatment (P = 0.355). There was no significant change in pulse rate or blood pressure.. Both latanoprost and brimonidine reduce IOP in NTG patients. Brimonidine has a peak IOP-lowering effect equal to that of latanoprost but produces a higher mean diurnal IOP than does latanoprost because of its shorter effect. Latanoprost might favorably alter optic disc blood perfusion by increasing OPP.

Topics: Adrenergic alpha-Agonists; Adult; Aged; Antihypertensive Agents; Blood Pressure; Brimonidine Tartrate; Cross-Over Studies; Drug Evaluation; Eye; Female; Glaucoma, Open-Angle; Heart Rate; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Optic Disk; Optic Nerve Diseases; Prostaglandins F, Synthetic; Quinoxalines; Vision Disorders; Visual Fields

Topics: Antihypertensive Agents; Drug Therapy, Combination; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Optic Nerve Diseases; Prostaglandins F, Synthetic; Timolol

To examine longitudinally optic disc structure and inner retinal function in treated ocular hypertension (OHT).. A morphometric (Heidelberg Retina Tomograph, HRT) and functional (steady-state pattern electroretinogram, PERG) evaluation of 27 OHT patients treated with topical beta-blockers and/or prostaglandin analogues and prospectively followed over a 24 +/- 6 month period.. Compared with baseline, mean final PERG amplitude tended to increase (p < 0.01), while HRT was stable. Individual PERG amplitude increase was large (>or= 100%) in some patients (5/27), and unexplained by clinical parameters at baseline.. In treated OHT, functional responses may improve while disc structure remains stable. The findings suggest that OHT-associated inner retinal dysfunction is at least in part reversible with therapeutic intraocular pressure control.

Topics: Adrenergic beta-Antagonists; Adult; Antihypertensive Agents; Drug Therapy, Combination; Electroretinography; Female; Follow-Up Studies; Humans; Intraocular Pressure; Lasers; Latanoprost; Male; Middle Aged; Ocular Hypertension; Ophthalmoscopy; Optic Disk; Optic Nerve Diseases; Prospective Studies; Prostaglandins F, Synthetic; Retina; Retinal Ganglion Cells

To perform a chart review to measure the validity of large claims databases in estimating patient cooperation with eyedrop therapy and to assess physician adherence with guidelines for a preferred practice pattern (PPP) using a new metric.. Claims database analysis, chart review, and telephone survey.. From 10,260 persons who were recently prescribed a prostaglandin eyedrop for open-angle glaucoma (OAG), a sample of 300 charts (3650 visits) was selected for detailed abstraction.. Database review of pharmacy refill, diagnostic testing, and visit information, with chart review of a sample of patients from the database and interviews with an overlapping sample of patients and physicians.. The individual patient medication possession ratio (MPR), an index estimating the proportion of time that patients have prescribed drug available for use, frequency of examination findings present in charts, and associations between MPR and physician adherence to a PPP.. Chart data confirm that the claims database accurately identified the specific glaucoma eyedrop prescribed, but often identified long-term OAG patients as being new to treatment. Physicians frequently used billing codes for OAG in patients with normal visual field tests. Physicians varied dramatically in their adherence to the PPP, performing intraocular pressure measurements, disc evaluations and imaging, and visual field tests on 90% of OAG patients, but carrying out gonioscopy, central corneal thickness measurement, and setting of target intraocular pressure (IOP) on half of patients.. Large claims databases permit conclusions regarding patient cooperation with glaucoma eyedrop therapy, but they should be used cautiously in imputing severity of disease and prior treatment history. Physician adherence to practice guidelines varied substantially; thus, scoring systems for physician behavior have promise in measuring outcome improvements related to better care.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Drug Prescriptions; Drug Utilization; Female; Glaucoma, Open-Angle; Guideline Adherence; Health Services Research; Health Surveys; Humans; Insurance Claim Review; Intraocular Pressure; Latanoprost; Lipids; Male; Middle Aged; Ophthalmic Solutions; Optic Disk; Optic Nerve Diseases; Patient Compliance; Practice Guidelines as Topic; Practice Patterns, Physicians'; Prostaglandins F, Synthetic; Travoprost; United States; Visual Fields

Topics: Antihypertensive Agents; Disease Progression; Female; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Latanoprost; Middle Aged; Myopia; Optic Disk; Optic Nerve Diseases; Prostaglandins F, Synthetic; Retinal Hemorrhage; Vision Disorders; Visual Acuity; Visual Fields

The combination of characteristic optic nerve head cupping, arcuate visual field loss and ocular hypertension would usually be thought sufficient to diagnose glaucoma. Only in the absence of elevated intraocular pressure, when normal tension glaucoma may be suspected, would intracranial imaging normally be performed to exclude occult pathology. A case is presented which illustrates the continuing need for vigilance, and an open mind, years after an apparently straight-forward diagnosis has been made.

Topics: Aged; Antihypertensive Agents; Central Nervous System Cysts; Female; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Latanoprost; Magnetic Resonance Imaging; Ocular Hypertension; Optic Disk; Optic Nerve Diseases; Pituitary Neoplasms; Prostaglandins F, Synthetic; Vision Disorders; Visual Fields

Topics: Adrenergic alpha-Agonists; Aniridia; Brimonidine Tartrate; Child; Drug Therapy, Combination; Glaucoma; Humans; Intraocular Pressure; Lasers; Latanoprost; Male; Ophthalmoscopy; Optic Disk; Optic Nerve Diseases; Prostaglandins F, Synthetic; Quinoxalines; Trabeculectomy; Visual Acuity