travoprost and Glaucoma

Glaucoma is a major cause of irreversible blindness worldwide. Reducing intraocular pressure (IOP) is currently the only approach to prevent further optic nerve head damage. Pharmacotherapy is the mainstay of treatment for glaucoma patients. In recent years, a significant milestone in glaucoma treatment has been a transition to prostaglandin analogs (PGAs) as the first line of drugs. The rapid shift from traditional β-blockers to PGAs is primarily due to their excellent efficacy, convenient once-a-day usage, better diurnal control of IOP, and systemic safety profiles. This review article aims to provide information regarding the various PGAs in practice and also the newer promising drugs.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Ophthalmology; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Travoprost

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

The objective of this meta-analysis was to evaluate the effect of prostaglandin analogues (PGA) on central corneal thickness (CCT) in patients with glaucoma. Key electronic databases were searched for randomized controlled trials (RCTs) involving the CCT effects of prostaglandin use for glaucoma. Primary outcome measures were the mean difference in the CCT measurement from baseline to the last available assessment. Intraocular pressure and other corneal changes were recorded as secondary. Efficacy estimates were measured by their weighted mean difference (WMD) with 95% confidence intervals (CI's) by using the random-effects model for primary and secondary outcomes Trial sequential analysis was used to determine if the current evidence was sufficient and conclusive. Eight RCTs met our inclusion criteria. A total of 879 patients were included. The overall effect showed that PGA's had a significant CCT lowering effect (WMD = -7.04, 95%CI: -10.07 to -4.00, P < 0.00001). We pooled results of 5 RCT's on Travoprost (WMD = -10.44, 95%CI: -16.80 to -4.08, P = 0.001), seven trials on Latanoprost (WMD = -4.73, 95% CI: -9.70 to 0.25, P = 0.06), and three trials on Bimatoprost (WMD = -11.88, 95%CI: -21.03 to -2.73, P = 0.01). The WMD across groups in >6 months of PGA use was -11.37 (95%CI: -17.17 to -5.58, P = 0.0001), and in <6 months of PGAs group was -8.35 (95% CI: -12.01 to -4.69, P < 0.00001), suggesting a longitudinal effect of PGAs on CCT. In conclusion, Bimatoprost and Travoprost caused a statistically significant reduction in the thickness of central cornea. Though only a few studies were included, the narrow confidence intervals and adequate sample size suggest that these findings are valid.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Glaucoma; Glaucoma, Open-Angle; Humans; Prostaglandins A; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Travoprost

Topics: Animals; Antihypertensive Agents; Bimatoprost; Drug Discovery; Glaucoma; Humans; Prostaglandins; Prostaglandins F; Travoprost; Treatment Outcome

This study will evaluate the efficacy of travoprost for patients with glaucoma systematically.. A comprehensive literature search will be carried from following literature sources from inception to the present: Cochrane Library, MEDLINE, EMBASE, Web of Science, Google scholar, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will only consider randomized controlled trials on assessing the efficacy and safety of travoprost for glaucoma for inclusion. We will use Cochrane risk of bias tool for the methodological quality assessment for each qualified study. If it is possible, we will pool the outcome data, and will perform meta-analysis.. This study will systematically evaluate the efficacy and safety of travoprost for glaucoma. Primary outcomes include intraocular pressure (IOP), mean IOP, and mean reduction of IOP. Secondary outcomes consist of diastolic ocular perfusion pressure, central corneal thickness, and quality of life, as measured by 36-Item Short Form Health Survey, and treatment-related adverse events included hyperemia, eye pain, and eye pruritus.. The findings of the present study will summarize the updated evidence of travoprost for patients with glaucoma.PROSPERO registration number: PROSPERO CRD42019126956.

Topics: Antihypertensive Agents; Corneal Pachymetry; Eye Pain; Glaucoma; Humans; Hyperemia; Intraocular Pressure; Pruritus; Quality of Life; Randomized Controlled Trials as Topic; Travoprost

Glaucoma is a leading cause of irreversible blindness worldwide and the second most common cause of blindness after cataracts. The primary treatment for glaucoma aims to lower intraocular pressure (IOP) with the use of topical medicines. Topical medication instillation techniques, such as eyelid closure and nasolacrimal occlusion when instilling drops, have been proposed as potential methods to increase ocular absorption and decrease systemic absorption of the drops.. To investigate the effectiveness of topical medication instillation techniques compared with usual care or another method of instillation of topical medication in the management of glaucoma or ocular hypertension.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 8 December 2016), Embase Ovid (1947 to 8 December 2016), PubMed (1948 to 8 December 2016), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 8 December 2016), International Pharmaceutical Abstracts Database (1970 to 8 December 2016), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (last searched 13 May 2013), ClinicalTrials.gov (www.clinicaltrials.gov) (searched 8 December 2016) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en) (searched 8 December 2016). We did not use any date or language restrictions in the electronic searches for trials.. We included randomized controlled trials which had compared any topical medication instillation technique with usual care or a different method of instillation of topical medication.. Two review authors independently screened records from the searches for eligibility, assessed the risk of bias, and extracted data. We followed methods recommended by Cochrane.. We identified two trials (122 eyes of 61 participants) that had evaluated a topical medication instillation technique. We also identified two ongoing trials. Both included trials used a within-person design and administered prostaglandin monotherapy for glaucoma or ocular hypertension. Because the trials evaluated different instillation techniques and assessed different outcomes, we performed no meta-analysis.One trial, conducted in the US, evaluated the effect of eyelid closure (one and three minutes) versus no eyelid closure on lowering IOP. At one to two weeks' follow-up, reduction in IOP was similar in the eyelid closure group and the no eyelid closure group (mean difference (MD) -0.33 mmHg, 95% confidence interval (CI) -0.8 to 1.5; 51 participants; moderate-certainty evidence).The second trial, conducted in Italy, evaluated the effect of using an absorbent cloth to wipe excess fluid after instillation (fluid removal) versus not using an absorbent cloth (no removal) on reducing dermatologic adverse events. At four months' follow-up, eyelashes were shorter among eyes in the fluid removal group compared with the no fluid removal group (MD -1.70 mm, 95% CI -3.46 to 0.06; 10 participants; low-certainty evidence). Fewer eyes showed skin hyperpigmentation in the eyelid region towards the nose in the fluid removal group compared with the no removal group (RR 0.07, 95% CI 0.01 to 0.84; 10 participants; low-certainty evidence); however, the difference was uncertain in the eyelid region towards the temples (RR 0.44, 95% CI 0.07 to 2.66; 10 participants; low-certainty evidence). The effect hypertrichosis (excessive hair growth) was uncertain between groups (RR 1.00, 95% CI 0.17 to 5.98; 10 participants; low-certainty evidence).Neither trial reported other outcomes specified for this review, including the proportion of participants with IOP less than 21 mmHg; participant-reported outcomes related to the ease, convenience, and comfort of instillation techniques; physiologic measurements of systemic absorption; escalation of therapy; mean change in visual fields; optic nerve progression; mean change in best-corrected visual acuity; proportion in whom glaucoma developed; quality of life outcomes; or cost-effectiveness outcomes. Neither trial reported data at follow-up times of more than four months.. Evidence to evaluate the effectiveness of topical medication instillation techniques for treatment of glaucoma is lacking. It is unclear what, if any, effects instillation techniques have on topical medical therapy for glaucoma.

Topics: Administration, Ophthalmic; Antihypertensive Agents; Bimatoprost; Eyelashes; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Ophthalmic Solutions; Prostaglandins F, Synthetic; Randomized Controlled Trials as Topic; Travoprost

Prostaglandin-timolol fixed combinations (PG-timolol FCs) are now widely used to reduce intraocular pressure in patients with glaucoma. The efficacy and tolerability of these drugs are worthy of further exploration. An updated systematic review and meta-analysis was performed to assess the clinical efficacy and tolerability of the three PG-timolol FCs.. Pertinent randomized, controlled trials were identified through systematic searches of PubMed, Embase, the Cochrane central register of controlled trials and the Chinese Biomedicine Database. The main efficacy measures were the weighted mean differences (WMDs) for the reduction from baseline to end of treatment in IOP at 9 am, 12 pm and 4 pm and diurnal curve. The main tolerability measures were the odds ratios (ORs) for the incidence of conjunctival hyperemia.. Nine studies involving 991 patients were included in the meta-analysis. Latanoprost-timolol FC (LTFC) and travoprost-timolol FC (TTFC) were not significantly different in lowering IOP at diurnal mean, 9 am, 12 pm and 4 pm. Bimatoprost-timolol FC (BTFC) provided significantly greater efficacy in lowering IOP at the three measurement time points and over the mean diurnal curve than LTFC (diurnal curve: WMD = 0.88 mmHg [95% CI, 0.42 to 1.33]; 9 am: WMD = 1.27 mmHg [0.68 to 1.86]; 12 pm: WMD = 1.16 mmHg [0.85 to 1.46]; 4 pm: WMD = 0.61 mmHg [0.51 to 0.70]) and TTFC (diurnal curve: WMD = 1.94 mmHg [0.19 to 3.68]; 9 am: WMD = 0.68 mmHg [0.15 to 1.21]; 12 pm: WMD = 0.90 mmHg [0.41 to 1.39]; 4 pm: WMD = 1.06 mmHg [0.61 to 1.51]). The incidence of hyperemia was significantly higher with BTFC than LTFC (pooled ORs: 1.85 [1.09 to 3.13]). The incidence of hyperemia was not significantly higher with TTFC than LTFC (pooled ORs: 2.52 [0.85 to 7.46]), and was not significantly higher with BTFC than TTFC (pooled OR: 1.65 [0.48 to 5.70]).. BTFC provided significantly greater efficacy in lowering IOP at diurnal mean, 9 am, 12 pm and 4 pm than LTFC and TTFC. LTFC was as effective as TTFC in lowering IOP at the four measurement time points and BTFC caused conjunctival hyperemia in more patients than LTFC. Further clinical trials are needed because of the limited number of studies.

Topics: Antihypertensive Agents; Bimatoprost; Drug Combinations; Glaucoma; Humans; Hyperemia; Intraocular Pressure; Latanoprost; Prostaglandins F, Synthetic; Timolol; Travoprost

Glaucoma is the second leading cause of blindness globally, representing a significant public health concern. More than 60 million people are affected by glaucoma worldwide; as this population ages, the number is expected to increase. Glaucoma is a collection of heterogeneous diseases sharing common clinical characteristics. The goal of treatment is to prevent significant visual dysfunction through reduction of intraocular pressure (IOP).. This is a review of the current literature about combination therapeutic regimens for the reduction of IOP, focusing on the risk : benefit profile of a fixed-combination therapy using travoprost and timolol.. Since the debut of prostaglandin analogues in the 1990s, only modest innovation has occurred in glaucoma pharmacology. A growing body of research has established that the preservative benzalkonium chloride (BAK) might not be the benign contributor expected of excipient ingredients. Thus, BAK-free treatments were developed, with the goal of IOP reduction without furthering ocular surface disease symptoms. The BAK-free travoprost/timolol combination represents an important addition to glaucoma medication options and may fill an unmet need in this therapeutic arena.

Topics: Animals; Antihypertensive Agents; Benzalkonium Compounds; Cloprostenol; Drug Combinations; Glaucoma; Humans; Preservatives, Pharmaceutical; Timolol; Travoprost

Modern fixed-combination products simplify medication dose regimen without sacrificing their effectiveness.Potential benefits of the therapy with fixed-combination products are enhanced tolerability increased convenience,better compliance,cost and time economy and removal of the wash out effect. Regarding intraocular pressure lowering effect, fixed-combination agents are superior to monotherapy with the two medication components, with the exception of Duotrav that is not superior to travoprost action.Fixed-combination products are noninferior to concomitant administration of the two components of medication (nonfixed-combination agents) relative to their ocular hypotensive efficacy with the exception of Ganfort that is however inferior to concurrent administration of both the bimatoprost and timolol.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Brimonidine Tartrate, Timolol Maleate Drug Combination; Carbonic Anhydrase Inhibitors; Cloprostenol; Drug Combinations; Drug Therapy, Combination; Glaucoma; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Latanoprost; Ophthalmic Solutions; Prostaglandins F, Synthetic; Quinoxalines; Sulfonamides; Thiazines; Thiophenes; Timolol; Travoprost; Treatment Outcome

The purpose of glaucoma treatment is to prevent progressive loss of optic nerve fibers and thereby to preserve the visual field. Because increased IOP is a primary risk factor in developing glaucoma, descrease its value below which may affect the optic is the antiglaucoma treatment target. This paper provides an overview of glaucoma treatment and the use of fixed combinations of topical prostaglandin analogues (PGA).

Topics: Amides; Antihypertensive Agents; Bimatoprost; Carbonic Anhydrase Inhibitors; Cloprostenol; Drug Combinations; Drug Therapy, Combination; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Optic Nerve; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Sulfonamides; Thiazines; Timolol; Travoprost; Treatment Outcome; Visual Fields

Lipid structural derivatives (latanoprost, travoprost and bimatoprost) are ocular hypotensive agents that significantly lower ocular tension with more than 30% from baseline by once-daily dosing.Ocular tension reduction from baseline is statistically significantly greater for bimatoprost than for latanoprost at all time points measured. Compared with travoprost, ocular tension decrease was statistically greater with bimatoprost at 8AM and 12PM. This trend was also seen at 4PM and 8PM, even though the difference was not statistically significant at the former time point and borderline at the latter time point. The findings for latanoprost and travoprost indicate that these two agents are comparable in their ability to reduce ocular pressure with no statistically significant difference seen at any time point measured. There does not exist any evidence, excepting conjunctival hyperemia which has been lesser with latanoprost compared to both the bimatoprost and travoprost, that any of these 3 medications significantly differs with respect to their adverse effects.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Drug Therapy, Combination; Evidence-Based Medicine; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Ophthalmic Solutions; Prostaglandins F, Synthetic; Travoprost; Treatment Outcome

To conduct a meta-analysis of randomised clinical trials (RCTs) in order to evaluate the development of conjunctival hyperaemia after the use of latanoprost versus travoprost and bimatoprost, in patients with ocular hypertension or glaucoma.. In order to identify the potentially relevant RCTs, a systematic literature retrieval was conducted in Medline, Embase and Cochrane Controlled Trials Register (1995-April 2007) databases The outcome measure was the appearance of conjunctival hyperaemia during the study. Statistical analyses included the calculation of odds ratio (OR) and its respective confidence interval, along with intertrial statistical heterogeneity. Publication bias was evaluated through a funnel plot, and a sensitivity analysis was also performed.. In total, 13 RCTs involving 2222 patients with ocular hypertension or glaucoma were included, five comparing latanoprost versus travoprost, seven comparing latanoprost versus bimatoprost and one comparing latanoprost versus travoprost and bimatoprost. The combined results showed that latanoprost produced lower occurrence of conjunctival hyperaemia than both travoprost (OR = 0.51; 95% CI 0.39 to 0.67, p<0.0001) and bimatoprost (OR = 0.32; 95% CI 0.24 to 0.42, p<0.0001). No significant heterogeneity was found between the included RCTs. There was no evidence of publication bias. In the sensitivity analysis performed, none of the clinical trials included in this meta-analysis has an important impact in the global estimation of OR.. According to available data, the use of latanoprost is associated with a lower incidence of conjunctival hyperaemia when compared with travoprost and bimatoprost in the treatment of patients with ocular hypertension or glaucoma.

Topics: Aged; Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Conjunctival Diseases; Female; Glaucoma; Humans; Hyperemia; Latanoprost; Male; Middle Aged; Ocular Hypertension; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Randomized Controlled Trials as Topic; Travoprost

To asses the association of conjunctival hyperemia with the use of a fixed combination of latanoprost/timolol, through a systematic review and meta-analysis of clinical trials in patients with glaucoma.. A systematic review of published clinical trials of latanoprost/timolol and other competitors was conducted in Medline, Embasse and Cochrane Controlled Clinical Trials Register, between 2000 and 2007. Statistical analysis included calculation of the odds ratio (OR) with its 95% confidence interval (CI) using the fixed effects model of Mantel-Haenszel and the random effects model of Der Simonian and Laird. To assess the heterogeneity between trials the Cochrane Q test and the I(2) rate were calculated. The conjunctival hyperemia rates obtained were compared with the Chi-square test.. A total of 8 clinical trials comparing latanoprost/timolol fixed combination with different therapeutic options were found. As trial heterogeneity was moderate (Q: 14.64; df=7; p=0.041; I(2)= 52.2%) a random effects model was used. The final OR was 0.47 (CI 95%: 0.24-0.90); p = 0.024. The total conjunctival hyperemia incidence was 2.9% in the latanoprost/timolol group and 7.0% for the competitors (p<0.0001).. The use of a fixed combination of latanoprost/timolol is associated with a significant reduction (53%; CI 95%: 10%-76%) in the development of conjunctival hyperemia against the other compared options for the treatment of glaucoma.

Topics: Aged; Brimonidine Tartrate; Clinical Trials as Topic; Cloprostenol; Conjunctival Diseases; Cross-Over Studies; Drug Combinations; Drug Therapy, Combination; Glaucoma; Humans; Hyperemia; Latanoprost; Middle Aged; Ocular Hypertension; Odds Ratio; Prostaglandins F, Synthetic; Quinoxalines; Sulfonamides; Thiazines; Timolol; Travoprost

Bimatoprost is a neutral lipid, a fatty acid amide that pharmacologically acts in both its paternal amide form and through its hydrolysis product (active free fatty acid of bimatoprost). Hypotensive ocular efficacy of bimatoprost is significantly superior to that of timolol and latanoprost. Mean ocular pressure decreases as well as percentages of reaching and sustaining the low targeting ocular pressures are higher comparing with travoprost. Conjunctival hyperemia produced by bimatoprost is statistically greater than that caused by timolol, latanoprost and travoprost; nevertheless it is well tolerated and mild in severity. Bimatoprost prostamide lowers ocular tension significantly and clinically relevant in patients uncontrolled with latanoprost; that is why bimatoprost can be used as additive or replacement therapy in patients who already receive maximal tolerated dose of latanoprost.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Drug Therapy, Combination; Evidence-Based Medicine; Glaucoma; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Latanoprost; Prostaglandins F, Synthetic; Randomized Controlled Trials as Topic; Timolol; Travoprost; Treatment Outcome

To assess the cost-efficacy of three fixed-combination glaucoma treatments currently available in Spain [bimatoprost with timolol (BT)- Ganfort, latanoprost with timolol (LT)- Xalacom, and travoprost with timolol (TT)- DuoTrav].. Because no studies are available that give a direct comparison of these drugs, a systematic review was carried out to assess their efficacy. Resource consumption and costs were estimated using a model of usual local practice. For each of the three drugs, average and incremental cost-efficacy ratios were determined in terms of euros per percentage point of reduction of intraocular pressure (IOP) over a three-month period.. BT reduced IOP by 35.1%, LT by 35.0% and TT by 34.7%. Average cost-efficacy was estimated to be euro 5.34 per percentage point of IOP reduction with BT, euro 5.40 with LT, and euro 5.45 with TT. Incremental cost-efficacy (incremental cost per incremental percentage point of IOP reduction) was estimated to be euro 94.65 for LT vs. TT, and was negative for BT vs. TT and BT vs. LT, since in both cases BT was more efficacious and less expensive.. Compared to travoprost/timolol and latanoprost/timolol, bimatoprost/timolol appears to be the most economic alternative, with equal or better efficacy and safety results.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Cost-Benefit Analysis; Drug Combinations; Glaucoma; Humans; Latanoprost; Middle Aged; Prostaglandins F, Synthetic; Timolol; Travoprost

Topics: Antihypertensive Agents; Cloprostenol; Drug Therapy, Combination; Glaucoma; Humans; Intraocular Pressure; Lasers; Ophthalmic Solutions; Prostaglandins F; Trabeculectomy; Travoprost

Fixed combinations represent a combination of two ocular hypotensive agents into one single ophthalmic solution. Current commercially available fixed combinations used in glaucoma treatment include Combigan, Cosopt, Xalcom, Duotrav and Ganfort. Statistically significant superiority of the ocular hipotensive efficacy of the fixed combinations vs monotherapy with the two individual constituents is present connected with Cosopt and Xalcom. It also exists vs timolol ophthalmic solution relative to Combigan, Duotrav and Ganfort but is missing within these fixed combinations vs brimonidine, travatan and bimatoprost respectively. A slight reduction, that is clinically and statistically insignificant relative to fixed combination efficacy vs the nonfixed combinations (e.g. concomitant but separate administration of the two individual components) is acceptable when this is balanced by potential benefits of the fixed combinations therapy (improved tolerability and convenience,increased compliance,cost and time economies,decreased washout effect and reduced exposure to preservatives).

Topics: Amides; Antihypertensive Agents; Bimatoprost; Brimonidine Tartrate; Cloprostenol; Drug Combinations; Drug Therapy, Combination; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Ophthalmic Solutions; Prostaglandins F, Synthetic; Quinoxalines; Sulfonamides; Thiophenes; Timolol; Travoprost; Treatment Outcome

To compare the efficacy of latanoprost, bimatoprost and travoprost for lowering IOP in patients with glaucoma.. In order to carry out this meta-analysis, randomized trials (2001-2004) were identified on Medline and EMBASE using the following key words: glaucoma, ocular hypertension (OHT), randomization, trial, latanoprost, bimatoprost and travoprost. The studies had to compare at least two prostaglandin analogues as mono-therapy. Cross-over experimental designs were excluded. The main outcome measure was IOP at final visit. Statistical analyses included random effects, pooled estimates of treatment effects, tests for publication bias, and random-effects models to obtain adjusted treatment effects on final IOP after lowering for baseline IOP, and duration of follow-up. Random effects Poisson regression models were used to estimate the adjusted effects of treatments on response rates (IOP < 18 mmHg).. Nine studies were used in the analysis. Patient mean age varied from 56.7 to 68.8 years and baseline IOP ranged from 22.3 to 26.5 mmHg. Three hundred and seventy-eight patients were treated with bimatoprost, 385 with travoprost and 555 with latanoprost. Patients treated with travoprost and bimatoprost had lower IOP levels at the end of follow-up (-0.98 mmHg [95% CI: -2.08; 0.13; p = 0.08] and -1.04 mmHg [95% CI: -2.11;0.04; p = 0.06], respectively) than those treated with latanoprost. The combined effect of newer prostaglandin analogues (bimatoprost/travoprost) was an adjusted decrease of 1.00 mmHg [95% CI: -1.91;-0.10], p = 0.03], or a 17% higher adjusted response rate (Incidence Rate Ratio 1.17, 95% CI, 1.00-1.35, p = 0.04), compared to latanoprost.. Travoprost and bimatoprost may have greater efficacy in lowering IOP for patients with OHT or glaucoma.

Topics: Administration, Topical; Aged; Amides; Bimatoprost; Cloprostenol; Confidence Intervals; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Male; Middle Aged; Ophthalmic Solutions; Probability; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Tonometry, Ocular; Travoprost; Treatment Outcome

Travoprost 0.004%/timolol 0.5% fixed combination (travoprost/timolol) is a once-daily eyedrops solution comprising the prostaglandin F(2alpha) analogue travoprost and the beta-adrenoceptor antagonist timolol. It is indicated for the treatment of patients with open-angle glaucoma or ocular hypertension who are insufficiently responsive to topical beta-adrenoceptor antagonists or prostaglandin analogues. Once-daily travoprost/timolol had generally similar efficacy to travoprost plus timolol and was more effective than travoprost or timolol monotherapy in reducing intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension in randomised, well designed studies. Both travoprost/timolol and latanoprost plus timolol maintained IOP control, and travoprost/timolol was shown to be noninferior to latanoprost/timolol in randomised, well designed studies. Travoprost/timolol was generally well tolerated, with a tolerability profile similar to those of travoprost plus timolol, travoprost or timolol monotherapy and latanoprost plus timolol. The majority of adverse events, such as ocular hyperaemia, were mild and resolved with or without treatment.

Topics: Cloprostenol; Drug Combinations; Glaucoma; Humans; Patient Compliance; Timolol; Travoprost

In the article the recent research on the biology of corneal stroma and biological impact of topical prostaglandin analogues on this tissue, were presented. The outcome of some studies, regarding influence of this class of antiglaucoma medication on central corneal thickness (CCT), were included. The impact of CCT on the readings of intraocular pressure and the aspect of diurnal fluctuations of CCT were also emphasized.

Topics: Administration, Topical; Cloprostenol; Cornea; Glaucoma; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ocular Hypertension; Ophthalmic Solutions; Prostaglandins F, Synthetic; Travoprost

In the first part of the article the main information and recent research on the uveoscleral outflow pathway, including its morphology and physiology were presented. The structure of extracellular matrix of ciliary muscle and the changes of it, that are induced by prostaglandins, resulting in decreasing intraocular pressure were emphasized. In the second part biochemical characteristics of prostaglandin analogues, using nowadays were presented. Their efficacy in reducing intraocular pressure and safety profile were described.

Topics: Amides; Bimatoprost; Cloprostenol; Dinoprost; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Prostaglandins F; Prostaglandins F, Synthetic; Receptors, Prostaglandin; Travoprost; Treatment Outcome

The prostaglandin derivatives are thought to lower intraocular pressure (IOP) primarily by increasing uveoscleral outflow. The ocular side effect, hyperemia, appears to occur via a secondary, unrelated mechanism. Variations in the IOP-lowering effect and incidence of hyperemia associated with these drugs are a function of their different chemical structures. Among the currently approved prostaglandin derivatives, hyperemia occurs in as many as 50% of patients treated with travoprost and as few as 5% of patients treated with latanoprost. The side effect of hyperemia may be of concern to the ophthalmologist for at least 2 reasons: hyperemia may compromise the outcome of filtration surgery, and it may represent a cosmetic problem to the patient thereby leading to non-compliance. The extent to which hyperemia may contribute to patient noncompliance and the effect of administration of the prostaglandin derivatives on outcome of filtration surgery remain to be determined. Until more definitive data are available, when selecting a prostaglandin analogue for ocular hypotensive therapy, it seems prudent to choose an agent with a low incidence of hyperemia.

Topics: Administration, Topical; Cloprostenol; Conjunctiva; Glaucoma; Humans; Hyperemia; Incidence; Intraocular Pressure; Latanoprost; Ocular Hypertension; Prostaglandins; Prostaglandins F, Synthetic; Travoprost

Prostaglandin analogs are a novel class of intraocular-lowering medications used primarily for the treatment of glaucoma. These topical medications reduce intraocular pressure primarily by enhancing uveoscleral outflow. The recent literature has enhanced our understanding of the mechanism of action, efficacy, and safety of these agents and has allowed us to better understand the differences between the three commonly used once-daily medications.

Topics: Administration, Topical; Amides; Bimatoprost; Cloprostenol; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Ocular Hypertension; Prostaglandins; Prostaglandins F, Synthetic; Safety; Travoprost

Bimatoprost (Lumigan [Allergan, Inc, Irvine CA]) and travoprost (Travatan [Alcon, Ft Worth, TX]) are two new intraocular pressure (IOP)-lowering drugs for use in patients with glaucoma and ocular hypertension. This review evaluates recent studies comparing these new drugs with timolol and with latanoprost. In each study, the statistical analyses support the conclusion that these agents were more effective than timolol and as effective as latanoprost in terms of their ability to reduce IOP. The side effect profiles for bimatoprost, latanoprost, and travoprost were similar, but with statistically higher occurrences of hyperemia and eyelash growth for bimatoprost or travoprost versus latanoprost or timolol.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Ocular Hypertension; Ophthalmic Solutions; Prostaglandins F, Synthetic; Randomized Controlled Trials as Topic; Timolol; Travoprost

Despite treatment, glaucoma patients may still suffer vision loss because of inadequate control of intraocular pressure or late presentation. This article reviews the latest evidence supporting a reappraisal of first-line treatment in the management of glaucoma, including a review of latanoprost, recently approved for first-line treatment of glaucoma and ocular hypertension.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Brimonidine Tartrate; Cloprostenol; Dinoprost; Drug Therapy, Combination; Glaucoma; Humans; Latanoprost; Lipids; Prostaglandins; Prostaglandins F, Synthetic; Quinoxalines; Sulfonamides; Thiophenes; Travoprost

Travoprost, a highly selective and potent analogue of the prostaglandin PGF(2)(alpha), has recently been approved and marketed as a topical ocular hypotensive agent for the treatment of ocular hypertension and glaucoma. Following absorption into the eye, the free acid form of travoprost interacts with the endogenous FP prostanoid receptor to enhance aqueous humor outflow and lower intraocular pressure (IOP). Travoprost is distinguished from other marketed prostaglandin analogues in that it is a full agonist at the prostaglandin receptor. It is also highly selective with little or no affinity for other prostanoid or non-prostanoid receptors in the eye. Travoprost provides robust lowering of IOP with little diurnal fluctuation and results in low target pressures in a large percentage of patients. In controlled clinical trials, travoprost 0.004% o.d. used as monotherapy produced greater IOP reduction than timolol 0.5% b.i.d. and equal or greater reduction than latanoprost 0.005%o.d. Travoprost 0.004% was also shown to be an effective adjunctive agent offering an additional 5 - 7 mmHg IOP reduction in patients inadequately controlled on timolol 0.5%. Subgroup analysis of a large Phase III trial revealed travoprost 0.004% to be significantly more effective at lowering IOP in African American patients by almost 2 mmHg compared to non-African Americans. Moreover, a higher percentage of African American patients responded to travoprost 0.004% and reached lower target pressures than with either latanoprost 0.005% or timolol 0.5%. Travoprost is a very stable compound, maintaining its efficacy following exposure to extremely low and high temperatures, repeated freezing and thawing and exposure to light. Throughout all clinical trials, travoprost was found to be safe and well-tolerated with very few (< 5%) discontinuations due to adverse events. Travoprost 0.004% represents a clinically significant advance for the treatment of glaucoma and ocular hypertension, offering superior IOP reduction and diurnal control, especially among African American patients, in a safe, well-tolerated, stable formulation.

Topics: Adrenergic beta-Antagonists; Antihypertensive Agents; Clinical Trials as Topic; Cloprostenol; Dose-Response Relationship, Drug; Drug Therapy, Combination; Glaucoma; Humans; Intraocular Pressure; Ocular Hypertension; Racial Groups; Receptors, Prostaglandin; Timolol; Travoprost

To compare the efficacies of latanoprost 0.005%, travoprost 0.004%, and tafluprost 0.0015% in reducing diurnal intraocular pressure (IOP) fluctuations in patients with newly diagnosed primary open-angle glaucoma (POAG).. In this prospective randomized clinical trial, 60 patients who were newly diagnosed with POAG were divided into three equal groups. Patients were examined at presentation and at second and sixth weeks. Diurnal phasing of IOP was conducted using a calibrated Goldmann applanation tonometer. IOP measurements were recorded from 8:00 am to 9:00 am, from 3:00 pm to 4:00 pm, and from 7:00 pm to 8:00 pm.. The study groups were distributed similarly in terms of age and gender (. Latanoprost, travoprost, and tafluprost show a similar effectiveness in reducing the mean IOP and the diurnal IOP fluctuation in POAG. Importantly, the three drugs have comparable tolerability with insignificant differences regarding the pattern of their side effects.

Topics: Adult; Aged; Antihypertensive Agents; Cloprostenol; Double-Blind Method; Glaucoma; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Latanoprost; Middle Aged; Ophthalmic Solutions; Prospective Studies; Prostaglandins F; Prostaglandins F, Synthetic; Travoprost; Treatment Outcome

To compare the effect of two different prostaglandin analogues (Travatan® vs. Xalatan®) on ocular surface parameters.. This study includes 44 eyes of 44 patients with newly diagnosed primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Patients were randomly divided into two groups and treated with either benzalkonium chloride (BAK)-preserved latanoprost and polyquad-preserved travoprost. Changes in intraocular pressure (IOP) levels and ocular surface parameters including ocular surface disease index (OSDI) questionnaire, tear breakup time (TBUT), ocular surface staining scores, and Schirmer test scores of patients were performed at baseline, 1, 3, 6, and 12 months of treatment and compared.. The age, sex ratio, visual acuity, central corneal thickness, and cup/disc ratio were similar between the groups. A decrease in IOP levels (23.3 ± 2.5 to 15.5 ± 2.3), TBUT (5.5 ± 2.3 to 4.1 ± 1.7 s), Schirmer test values (11.3 ± 5.9 to 8.6 ± 4.7 s), and a worsening in OSDI scores (44.6 ± 15.2 to 55.1 ± 13.1) and staining scores (1.7 ± 1.6 to 2.3 ± 1.8) were observed in all patients in the first month of treatment (p < 0.05, for all). No further worsening was detected during the 1-year follow-up. There was no difference between the groups in terms of alterations in IOP levels and ocular surface parameters.. Travatan® and Xalatan® have a similar effect on IOP levels and ocular surface parameters in patients with POAG and OHT.

Topics: Antihypertensive Agents; Cornea; Glaucoma; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Latanoprost; Ocular Hypertension; Ophthalmic Solutions; Polymers; Preservatives, Pharmaceutical; Prostaglandins F, Synthetic; Travoprost

To evaluate the systemic pharmacokinetics (PKs) of travoprost 0.004% preserved with Polyquad. This was a phase 1, open-label, multicenter clinical study of patients aged ≥2 months to <18 years. Patients received daily administration of travoprost 0.004% preserved with Polyquad in both eyes for 7 days. Plasma samples were collected 30 min before the final dose and at 10, 20, 40, and 80 min postdose. The main outcome measure was maximum concentration of travoprost free acid in plasma (C. Travoprost free acid concentration in plasma was low in pediatric patients, detectable in only 11 of 24 patients. There was no accumulation of travoprost over the course of treatment. No clear relationship was observed between age/body surface area and C

Topics: Adolescent; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Glaucoma; Humans; Infant; Male; Ophthalmic Solutions; Polymers; Preservatives, Pharmaceutical; Travoprost

To evaluate efficacy and safety of travoprost in pediatric patients with ocular hypertension or glaucoma and demonstrate its noninferiority to timolol.. Patients aged 2 months to <18 years with glaucoma or ocular hypertension were randomized to receive travoprost (0.004%) or timolol eye drops (0.25% for patients aged 2 months to <3 years and 0.5% for patients ≥3 years old) for 3 months in this double-masked, parallel-group study. Intraocular pressure (IOP) was measured and patients were evaluated at 2 weeks, 6 weeks, and 3 months after treatment. Change in IOP from baseline to 3 months was the primary endpoint, and the test of noninferiority was based on a margin of +3.0 mm Hg using the 95% 2-sided confidence interval of the mean change.. Of 157 patients included (mean age, 9.6 years), 77 received travoprost and 75 timolol. All patients experienced a significant reduction in IOP in the study eye at 3 months: the mean IOP change from baseline was -5.4 mm Hg for travoprost; -5.3 mm Hg, for timolol. The mean difference between travoprost and timolol at month 3 was -0.1 mm Hg (95% CI, -1.5 to 1.4 mm Hg). The most common treatment-related adverse events for the travoprost group were ocular hyperemia and eyelash growth. No serious adverse events were reported.. This study found travoprost to be noninferior to timolol in lowering IOP in patients with pediatric glaucoma or ocular hypertension. Travoprost was well-tolerated, and no treatment-related systemic adverse events were reported.

Topics: Adolescent; Antihypertensive Agents; Child; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Equivalence Trials as Topic; Female; Glaucoma; Humans; Infant; Intraocular Pressure; Male; Ocular Hypertension; Ophthalmic Solutions; Prospective Studies; Timolol; Tonometry, Ocular; Travoprost

Improving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or reduce progression of optic nerve damage. The present study used a behaviour change counselling intervention to determine whether education and support was beneficial and cost-effective in improving adherence with glaucoma therapy.. A randomised controlled trial with a 13-month recruitment and 8-month follow-up period was conducted. Patients with OH/glaucoma attending a glaucoma clinic and starting treatment with travoprost were approached. Participants were randomised into two groups and adherence was measured over 8 months, using an electronic monitoring device (Travalert® dosing aid, TDA). The control group received standard clinical care, and the intervention group received a novel glaucoma education and motivational support package using behaviour change counselling. Cost-effectiveness framework analysis was used to estimate any potential cost benefit of improving adherence.. Two hundred and eight patients were recruited (102 intervention, 106 control). No significant difference in mean adherence over the monitoring period was identified with 77.2% (CI, 73.0, 81.4) for the control group and 74.8% (CI, 69.7, 79.9) for the intervention group (p = 0.47). Similarly, there was no significant difference in percentage intraocular pressure reduction; 27.6% (CI, 23.5, 31.7) for the control group and 25.3% (CI, 21.06, 29.54) for the intervention group (p = 0.45). Participants in the intervention group were more satisfied with information about glaucoma medication with a mean score of 14.47/17 (CI, 13.85, 15.0) compared with control group which was 8.51 (CI, 7.72, 9.30). The mean intervention cost per patient was GB£10.35 (

Topics: Aged; Aged, 80 and over; Analysis of Variance; Antihypertensive Agents; Cloprostenol; Counseling; Female; Glaucoma; Health Care Costs; Humans; Intraocular Pressure; Male; Medication Adherence; Middle Aged; Ocular Hypertension; Patient Education as Topic; Patient Satisfaction; Patient-Centered Care; Travoprost

To compare the toxicity effect of polyquaternium (PQ) and benzalkonium chloride (BAK) preservation of travoprost on the ocular surface.. This prospective study included 44 eyes of 44 patients with newly diagnosed glaucoma. Twenty-two patients used PQ-preserved travoprost (PQ group) and 22 patients used BAK-preserved travoprost (BAK group). To investigate the effect on the ocular surface, conjunctival impression cytology (IC) was performed at baseline and the 1- and 6-month follow-up visits. Additionally, the ocular surface disease index (OSDI) questionnaire, Schirmer I test, and tear break-up time (TBUT) measurement were administered at baseline, and at 1-, 3-, and 6-month follow-up visits.. While both groups showed statistically significant IC grade increases at 1 and 6 months when compared with baseline measurements, IC grades were significantly higher for patients using PQ-preserved travoprost compared with patients using BAK-preserved travoprost. The Schirmer I test and TBUT scores were not statistically significant between group 1 and BAK group at baseline and at 1-, 3-, and 6-month visits (P>0.05). OSDI scores did not statistically differ at baseline and the 1-month measurements between the 2 groups (P>0.05), but the 3- and 6-month OSDI scores were significantly higher for BAK group (P=0.001). Differences in OSDI and Schirmer I test scores were statistically significant at 1, 3, and 6 months in both groups as compared with baseline values (P<0.05). Statistically significant differences in the TBUT scores were seen for both groups at 3 and 6 months, while BAK group, but not PQ group, had insignificant score differences at 1 month as compared with baseline values of PQ group (P=0.083).. PQ-preserved travoprost was found to be safer and better-tolerated than BAK-preserved travoprost. PQ-preserved travoprost provided better ocular surface comfort, and therefore a better patient experience, which would likely result in higher treatment compliance.

Topics: Benzalkonium Compounds; Cloprostenol; Cornea; Cytological Techniques; Female; Glaucoma; Humans; Male; Middle Aged; Polymers; Preservatives, Pharmaceutical; Prospective Studies; Surface Properties; Travoprost

To determine if adherence and convenience of once-daily glaucoma medication is greater in the morning or the evening.. Prospective, randomized crossover treatment trial.. Thirty patients newly diagnosed with glaucoma or ocular hypertension requiring intraocular pressure (IOP) reduction were started on travoprost eye drops and randomized to either morning or evening administration for 1 month. They were then crossed over to the opposite dosing schedule for the following month. Adherence was monitored using an automated dosing aid.. Adherence was compared between morning versus evening dosing and first versus second month dosing. Demographic characteristics were obtained, treatment effect was measured, and patients completed a post-study questionnaire regarding the convenience of the 2 dosing regimens.. Patient adherence overall was good (89.3%). There was no statistically significant difference (P=0.07) in adherence between morning dosing (90.9%) and evening dosing (87.3%). Adherence in the first month (91.7%) was superior to the second month (86.5%). There was no significant difference in IOP response between morning and evening dosing. Patients found morning dosing more convenient than evening dosing.. Early adherence to treatment with a prostaglandin analogue is good, but patients prefer morning administration to evening administration. This may lead to greater adherence with morning administration, particularly among men. Adherence decreases from the first to second month after initiation of treatment. IOP response to this treatment is not significantly affected by morning versus evening administration.

Topics: Administration, Topical; Aged; Aged, 80 and over; Antihypertensive Agents; Cloprostenol; Cross-Over Studies; Drug Chronotherapy; Female; Glaucoma; Humans; Intraocular Pressure; Male; Medication Adherence; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Prospective Studies; Surveys and Questionnaires; Travoprost

To determine if eyelid closure (ELC) after topical prostaglandin instillation provides greater intraocular pressure (IOP) reduction than prostaglandin instillation without ELC.. Patients receiving chronic bilateral prostaglandin monotherapy were enrolled in this study. The study intervention, ELC, was randomly assigned to one eye, while the fellow eye served as control. ELC was performed for either 1 min or 3 min. After a 1-day washout, the IOP was measured in a masked fashion at baseline, 1 h and 24 h, and at a final visit that took place 7-14 days after enrolment. All visits were scheduled during the morning, and every individual patient's visits occurred at similar times during the day. The main outcome was difference between intervention eye and control eye in IOP-lowering from baseline.. 51 patients meeting eligibility criteria were enrolled: 25 were randomised to ELC for 1 min and 26 to ELC for 3 min in the intervention eye. The pooled IOP-lowering difference (95% CI, p value) in intervention versus control eyes was 0.24 mm Hg (-0.5 to 0.9, p=0.50), 0.24 mm Hg (-0.7 to 1.2, p=0.61) and 0.24 mm Hg (-0.7 to 1.2, p=0.61) in the overall group, 1 min ELC subgroup and 3 min ELC subgroup, respectively. The effect of ELC did not change significantly across visits.. ELC did not provide significant additional IOP reduction compared with no ELC in patients using chronic prostaglandin monotherapy. Trial Registration http://clinicaltrials.gov/ct2/show/NCT0083283.

Topics: Absorption; Aged; Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Eyelids; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Prostaglandins F, Synthetic; Time Factors; Tonometry, Ocular; Travoprost

To evaluate the changes in intraocular pressure (IOP) and pupil size in 12 Beagles with inherited glaucoma after instillations of 0.033, 0.0033, 0.001, 0.00033, and 0.0001% travoprost (Travatan®-Alcon Laboratories, Inc., Ft Worth, TX, USA) in multiple single-dose studies.. Intraocular pressure and pupil diameter (PD) measurements were obtained at 9 am, 12 pm, 3 pm, and 9 am the following day (24 h) in two groups of six glaucoma dogs. After 7 days, the vehicle or concentration was repeated in the contralateral eye of the same animals.. Concentrations of 0.00033, 0.001, and 0.0033% travoprost significantly lowered IOP and PD, but the 0.0001% concentration provided limited IOP changes, although PD changes were still significant. This suggests travoprost is effective in the dog to lower IOP and reduce pupil size at concentrations starting between 0.0001 and 0.00033%.. The dose response for travoprost in the glaucomatous Beagle indicates this model is highly sensitive to this group of drugs, even at concentrations as low as 0.00033% (1/12 the commercially available concentration).

Topics: Animals; Cloprostenol; Cross-Over Studies; Dog Diseases; Dogs; Dose-Response Relationship, Drug; Female; Glaucoma; Male; Travoprost

To study compliance in the medical treatment of glaucoma, its possible association with other factors, and quality of life of patients with glaucoma.. Longitudinal prospective study of 60 patients with ocular hypertension or glaucoma who were treated with travoprost, or with a fixed combination of travoprost/timolol nightly. All subjects were given a Travalert(®) dosing aid and were reviewed after one and four months. Strict and relative compliance data were collected on each visit. The relationship between compliance and other variables was studied using univariate analysis. To analyse quality of life, patients were given self-assessment STAI anxiety questionnaires after the first and last visits.. Relative compliance for the four months was significantly greater than the strict compliance (P=.001). In the group of least compliance the number of patients on treatment with combination therapy was significantly higher than those on monotherapy. In the lost cases, the number of men was significantly higher than women. No association was found in the other variables. The anxiety was similar to that in the normal population.. Compliance is very important in the treatment of glaucoma, and our study provides objective data through the use of Travalert dosing aid with relative compliances of 70%. Patients with combined therapies have lower compliance than those on monotherapy.

Topics: Administration, Ophthalmic; Aged; Anxiety; Cloprostenol; Drug Administration Schedule; Drug Combinations; Female; Follow-Up Studies; Glaucoma; Humans; Instillation, Drug; Male; Medication Adherence; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Prospective Studies; Quality of Life; Reminder Systems; Surveys and Questionnaires; Timolol; Travoprost

To evaluate 24-h efficacy of travoprost/timolol fixed combination (TTFC) vslatanoprost/timolol fixed combination (LTFC) in exfoliative glaucoma (XFG).. A prospective, single-masked, crossover, active-controlled, randomized 24-h comparison.. After up to a 6-week medicine-free period, XFG patients were randomized to either TTFC or LTFC for 3 months, dosed each evening, and then changed to the opposite treatment for another 3 months. At the end of the washout, and both treatment periods, a 24-h intraocular pressure (IOP) curve was measured.. In total, 40 patients completed the study. The TTFC group showed a lower mean absolute 24-h IOP (18.7±2.6 vs 19.6±2.6 mm Hg, P<0.001), maximum IOP (20.5±2.6 vs 21.5±2.6 mm Hg, P<0.001) and 24-h IOP range (3.4±1.3 vs 4.1±1.6 mm Hg, P=0.01). At individual time points, TTFC showed reduced IOPs compared with LTFC, after a Bonferroni correction, at 1000, 1800, and 2200 hours (P≤0.04). No statistical differences existed at hours: 0600, 1400, and 0200 (P≥0.05) and for the minimum IOP (P=0.09).. This study suggests that evening-dosed TTFC may provide greater 24-h IOP reduction, primarily at the 1800 hours time point, compared with LTFC in XFG.

Topics: Aged; Antihypertensive Agents; Cloprostenol; Cross-Over Studies; Drug Administration Schedule; Drug Therapy, Combination; Exfoliation Syndrome; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Prospective Studies; Prostaglandins F, Synthetic; Single-Blind Method; Time Factors; Timolol; Travoprost

To investigate the impact of an intervention program to improve adherence with topical, once daily therapy for glaucoma.. Randomized controlled clinical trial.. Sixty-six patients with glaucoma being treated with a prostaglandin analog in 1 or both eyes at the Scheie Eye Institute or Wilmer Eye Institute between November 2006 and June 2007.. In an observational study, participants who took 75% or fewer doses (as measured using the travoprost Dosing Aid [DA]) during an initial 3-month period were randomized into 2 groups. The intervention group watched an educational video, reviewed current barriers to drop-taking and possible solutions with a study coordinator, received regular phone call reminders, and had audible and visible reminders activated on their DA devices. The control group was told to take drops as prescribed and received no additional intervention.. Change in drop use adherence as determined by the DA device.. In the 3-month observation period before randomization, intervention group patients had used a mean of 54+/-17% of scheduled doses, and this increased to 73+/-22% during the following 3-month period (P<0.001, n = 35). The control mean adherence rate of 46+/-23% at baseline was statistically unchanged during the follow-up observation period (51+/-30%, P = 0.16, n = 31). In a multivariate analysis, intervention, baseline compliance rate of <50%, and white ethnicity were predictors of improved adherence during the 3 months of intervention. The intraocular pressure (IOP) of the intervention and control groups did not change between months 3 and 6 after intervention (P = 0.96, 0.34, respectively), and there was no correlation of IOP change with adherence rate change between both groups (Pearson correlation r = 0.06, P = 0.51).. A multifaceted intervention significantly increased adherence with glaucoma medications. Those with improved adherence were in the intervention group, had very low adherence rates at baseline, and were white. IOP did not correlate with adherence. Further research is needed to determine which components of this intervention were most effective.

Topics: Aged; Aged, 80 and over; Antihypertensive Agents; Cloprostenol; Drug Monitoring; Female; Follow-Up Studies; Glaucoma; Humans; Intraocular Pressure; Male; Medication Adherence; Middle Aged; Ophthalmic Solutions; Patient Compliance; Patient Education as Topic; Prospective Studies; Travoprost; Video Recording

To determine the medium-term effect of travoprost on the daytime intraocular pressure (IOP) of patients with normal tension glaucoma (NTG) METHODS: Newly diagnosed NTG patients underwent baseline, daytime, hourly IOP phasing. Patients were randomised to either treatment or no treatment (control). Treatment comprised once daily topical travoprost 0.004%. After 6 months, the participants underwent their second IOP phasing.. Data from 88 participants were analysed-54 were randomised to treatment and 34 to the control group. The mean duration of treatment was 6 months. The average, maximum and minimum diurnal IOPs for treated patients were statistically significantly lower than for control patients at follow-up (p<0.001). When compared with baseline IOP, the travoprost treated group demonstrated a decrease of 16.1%, 13.5% and 16.7% in the average IOP, maximum IOP, and minimum IOP respectively. Of those treated, about one-third achieved a decrease in average IOP of at least 20%; only about one-tenth achieved a reduction of at least 30%.. Travoprost monotherapy had a sustained hypotensive effect in NTG and achieved a reasonable or good response (>20% reduction in average IOP) in 32.9% of treated eyes. However, in the majority of eyes with NTG, travoprost monotherapy appeared unable to produce the desirable 30% reduction in average IOP.

Topics: Aged; Antihypertensive Agents; Circadian Rhythm; Cloprostenol; Female; Follow-Up Studies; Glaucoma; Humans; Intraocular Pressure; Male; Middle Aged; Single-Blind Method; Travoprost; Treatment Outcome

This study compares intraocular pressure (IOP)-lowering efficacy and retrobulbar hemodynamic effects of bimatoprost and travoprost in patients with newly diagnosed open-angle glaucoma.. Patients were randomly assigned to one of two treatment groups (bimatoprost group, n = 36; travoprost group, n = 46). IOP levels were measured with Goldmann applanation tonometer. Peak systolic velocity, end-diastolic velocity and resistivity index were obtained for each vessel by color Doppler imaging.. Both bimatoprost and travoprost significantly lowered IOP on days 30, 90 and 180 (p < 0.001). There was no significance between the 2 drugs on all follow-up visits. End-diastolic velocity of central retinal artery on day 180 was significantly higher than the value obtained at baseline in both groups.. Patients were likely to achieve and maintain low target IOP with both drugs. Both drugs also resulted in improvement in the central retinal artery blood flow.

Topics: Adult; Aged; Aged, 80 and over; Amides; Bimatoprost; Blood Flow Velocity; Cloprostenol; Diastole; Eye; Female; Follow-Up Studies; Glaucoma; Hemodynamics; Humans; Intraocular Pressure; Lipids; Male; Middle Aged; Regional Blood Flow; Retinal Artery; Time Factors; Travoprost; Ultrasonography, Doppler, Color

To investigate if combined intraocular pressure (IOP)-lowering medication with travoprost/timolol fixed combination and a carbonic anhydrase inhibitor, brinzolamide, is superior to both travoprost monotherapy and travoprost/timolol fixed-combination therapy in primary open-angle glaucoma and ocular hypertension.. Following a 4-week wash-out period and using 4-week long treatment periods, 20 primary open-angle glaucoma or ocular hypertension patients were treated with evening travoprost 0.004%, then switched to evening travoprost 0.004%/timolol 0.5% fixed combination, and finally the treatment was combined with adjunctive twice-daily brinzolamide 1% ophthalmic suspension. Both eyes were treated, but only one eye per patient (the eye with the higher mean diurnal IOP at baseline), was evaluated. IOP was measured at 8 a.m., 12 noon and 4 p.m. at baseline and at the end of each treatment period.. Mean diurnal IOP (mean (SD)) at baseline was 28.5 (7.3) mmHg which decreased to 22.3 (6.3) mmHg on travoprost, 19.2 (3.4) mmHg on travoprost/timolol fixed combination and 17.3 (3.4) mmHg when the brinzolamide was added to the travoprost/timolol combination (ANOVA, contrast test, p<0.003 for all comparisons). The individual time point IOP values showed similar and significant stepwise differences.. Adjunctive brinzolamide medication provided further IOP decrease in patients receiving evening-dosed travoprost/timolol fixed combination. The travoprost/timolol fixed combination was significantly more effective in IOP reduction than travoprost monotherapy, which by itself induced a significant IOP decrease compared to the untreated baseline value. The results of this open label study suggest that combined therapy with travoprost/timolol fixed combination and brinzolamide is clinically useful for IOP-lowering in primary open-angle glaucoma and ocular hypertension.

Topics: Aged; Cloprostenol; Drug Combinations; Drug Therapy, Combination; Female; Glaucoma; Humans; Intraocular Pressure; Male; Middle Aged; Sulfonamides; Thiazines; Timolol; Travoprost

Intraocular pressure (IOP) fluctuation over 24 hours is an independent risk factor for glaucoma progression. Nighttime lOP measurement is not routine practice.. The aim of this study was to predict, using a Bayesian network (BN), the likelihood of a nighttime IOP peak >18 mm Hg based on daytime measurements.. A pooled analysis was conducted using a BN. Data from 3 clinical trials of adult patients with glaucoma or ocular hypertension were used. IOP values at 0800, 1200, 1600, and 2000 hours were dichotomized according to the 18-mm Hg threshold. Patients' lOPs were assessed from the pretreatment washout periods and during latanoprost or travoprost treatments. A BN was constructed to study associations between daytime and nighttime IOP values, and prostaglandin analogue IOP control adjusted for trial. The nighttime IOP peak was defined as the maximum IOP value between 2400 and 0400 hours.. The study identified 382 daily IOP vectors (6 measures per day, every 4 hours for 24 hours; pretreatment, 208; latanoprost, 73; travoprost, 101). Based on the BN, IOP at 0800 hours was associated with IOP at 1200 hours, which was also associated with the IOP at 1600 hours. IOP at 2000 hours was predicted by the IOPs at 1200 and 1600 hours. The nighttime IOP peak was associated with IOP >18 mm Hg at 1200 and 2000 hours. The percentage of patients with controlled IOP at 1200 and 2000 hours was higher in those receiving travoprost than in those receiving latanoprost. Travoprost was also associated with an increased probability of controlling nighttime IOP values >18 mm Hg (travoprost, 76.9%-77.5% vs latanoprost, 66.7%-67.9%). Daily IOP fluctuations were not found to be associated with nighttime IOP peak.. Daytime IOP measurements are highly intercorrelated. According to this BN, IOP at 1200 and 2000 hours are more strongly associated with the nighttime IOP peak than other IOP measurements. BN can estimate the risk of a nighttime IOP peak >18 mm Hg. Daytime IOP control was important for nighttime IOP control. These findings require validation in a clinical setting.

Topics: Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Bayes Theorem; Circadian Rhythm; Cloprostenol; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Models, Biological; Ocular Hypertension; Prostaglandins F, Synthetic; Reproducibility of Results; Travoprost; Treatment Outcome

The aim of this study was to compare the tolerability and efficacy of once-daily travoprost 0.004% versus latanoprost 0.005% for 6 weeks followed by 6 weeks of once-daily travoprost 0.004% in decreasing intraocular pressure (IOP) in patients with open-angle glaucoma (OAG) or ocular hypertension (OH).. This multicenter, randomized, doublemasked, active-controlled, parallel-group trial was conducted at 32 centers across Latin America. Patients aged > or =18 years with OAG or OH were randomly assigned to receive topical travoprost 0.004% or latanoprost 0.005% 1 drop QD (9 PM) for 6 weeks (masked phase). At 6 weeks, all patients were assigned to receive open-label travoprost 0.004% 1 drop QD (9 PM) for 6 additional weeks (open-label phase). Study visits were scheduled at weeks 1, 2, 4, 6, 8, and 12. At each study visit, IOP was measured at 5 PM (+/-1 hour; approximately 20 hours after study drug administration). IOP changes from baseline were combined (pooled) from the 1-, 2-, 4-, and 6-week data to provide a comparison between the 2 treatment groups. Ocular adverse events (AEs) were monitored using slit-lamp examination.. A total of 302 patients were enrolled (travoprost group, 155 patients; latanoprost group, 147 patients). The mean (SD) age of the travoprost group was 61.9 (10.6) years; 60.6% were female; and 47.1% were white. The mean (SD) age of the latanoprost group was 60.5 (12.4) years; 62.6% were female; and 49.0% were white. Mean IOP values were not significantly different between the travoprost and latanoprost groups at baseline (24.7 vs 24.2 mm Hg) or 6 weeks; however, the between-group difference in reductions from baseline in pooled IOP during the masked phase of the study was statistically significant (-8.3 vs -7.5 mm Hg; P = 0.009). At weeks 6 and 12, mean lOP levels were 16.1 and 16.2 mm Hg, respectively, in the travoprost group and 16.4 and 16.1 mm Hg in the group that was switched from latanoprost to travoprost (all, P = NS). The most common ocular AEs that occurred with masked travoprost, latanoprost, and open-label travoprost were hyperemia (26.9%, 12.2%, and 5.3%, respectively), discomfort (3.2%, 3.4%, and 1.1%), and pruritus (4.5%, 2.0%, and 2.1%).. In this population of patients with OAG or OH, 6-week treatment with travoprost 0.004% was associated with a significantly greater decrease from baseline in pooled IOP compared with latanoprost 0.005% 20 hours after administration. There were no significant differences between the 2 groups. Travoprost and latanoprost were well tolerated.

Topics: Administration, Topical; Analysis of Variance; Antihypertensive Agents; Cloprostenol; Double-Blind Method; Drug Administration Schedule; Female; Glaucoma; Glaucoma, Open-Angle; Gonioscopy; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Ophthalmic Solutions; Prostaglandins F, Synthetic; Tonometry, Ocular; Travoprost; Treatment Outcome; Visual Acuity

This study contrasts the utilization of adjunctive medication associated with travoprost, bimatoprost, or latanoprost, as primary glaucoma therapies.. Patients in the Medco Health database who initiated prostaglandin analog therapy on travoprost, bimatoprost or latanoprost between January 1, 2002 and July 31, 2002 were selected if they had no prostaglandin analog use in the prior 6 months. Patients were also required to have 12 months of prostaglandin therapy subsequent to the initial prescription. Data were available through July 31, 2003. The t-test and chi-square were used where appropriate to calculate p-values and assess significant differences.. A total of 13 171 benefit-eligible subjects were identified of which 8381 (64%), 2637 (20%), and 2153 (16%) patients were treated with latanoprost, bimatoprost, and travoprost, respectively. There were no significant differences in mean age or gender between the three study groups with the exception that latanoprost patients were statistically older than travoprost patients (69.0 vs. 68.0). This was not considered a clinically meaningful difference. Overall, patients using travoprost or bimatoprost had a significantly lower rate of adjunctive medication use compared to patients starting on latanoprost monotherapy (22.5%, 23.2%, and 30.2 %, respectively). Therefore, for every 14 patients treated with latanoprost instead of travoprost or bimatoprost, one additional patient would be expected to need adjunctive therapy with another agent. The difference between travoprost and bimatoprost patients was not significant.. The use of adjunctive medications to control intraocular pressure was significantly higher for latanoprost patients compared to travoprost and bimatoprost patients. This finding should be interpreted in the context that this study was based only on prescription claims data. It is important to simplify ophthalmic medical regimen as it is more cost effective, better for the patient, and minimizes the washout effect from administering two eye medications within 5 min. Decreasing the complexity of the patients' drug regimen may lead to increased adherence to prescribed therapy and a decreased risk of the incidence of blindness.

Topics: Aged; Amides; Bimatoprost; Cloprostenol; Drug Therapy, Combination; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Male; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Travoprost

The objective of this study was to assess the hypotensive efficacy of timolol maleate 0.5%, brinzolamide 1%, or brimonidine tartrate 0.2% ophthalmic solution, administered in conjunction with travoprost 0.004%, in patients with primary open-angle laucoma (OAG) or ocular hypertension (OHT) whose intraocular pressure (IOP) did not meet the treatment target using travoprost 0.004% monotherapy.. This was a randomized, comparative, investigator-masked study. Patients with OAG or OHT treated with travoprost 0.004% monotherapy were randomized to receive 1 of the 3 adjunctive therapies (timolol maleate 0.5%, brinzolamide 1%, or brimonidine tartrate 0.2%), 1 drop BID in each randomized eye, in addition to 1 drop QD of travoprost for a period of 4 weeks. IOP was measured on days 0 (travoprost 0.004%) and 28 (travoprost 0.004% and adjunctive treatment). Adverse events were monitored on days 0 and 28 by patient interview.. Twenty-nine patients with OAG (46 eyes) and 3 patients with OHT (6 eyes), with a total of 52 eligible eyes, completed the study; 28 eyes were from male patients and 24 were from female patients. In addition to continuing travoprost treatment, 20 eyes received timolol, 16 eyes received brinzolamide, and 16 eyes were treated with brimonidine. There were no significant differences among the groups in the mean (SD) IOP at baseline on day 0 (19.0 [4.1], 17.2 [3.5], and 17.0 [3.1] mm Hg, respectively; P=NS). On day 28, the reduction in mean (SD) IOP in eyes treated with brimonidine tartrate 0.2% was significantly smaller (2.3 [1.8] mm Hg vs 3.9 [1.8] mm Hg [P=0.01]) and the mean (SD) percentage reduction in IOP was significantly smaller (13.4% [9.1%] vs 20.2% [7.5%] [P=0.01]) when compared with timolol maleate 0.5%, and likewise when compared with brinzolamide 1% (4.0 [2.1] mm Hg [P=0.02] and 22.7% [8.6%] [P=0.006], respectively). The group treated with brinzolamide was associated with a similar reduction in IOP to timolol (P=NS for both mean [SD] IOP and percentage reduction in IOP compared with timolol monotherapy). Barring the occasional conjunctival hyperemia, which was excluded as an adverse event for the purposes of this study, no adverse events were recorded.. Brinzolamide 1% and timolol maleate 0.5% treatment were both associated with a significantly greater reduction in IOP compared with brimonidine 0.2% when administered as a nonfixed adjuvant to travoprost 0.004% in the treatment of patients with OAG and OHT whose IOP was inadequately controlled with travoprost monotherapy. All treatments were well tolerated.

Topics: Adrenergic alpha-Agonists; Adrenergic beta-Antagonists; Aged; Brimonidine Tartrate; Carbonic Anhydrase Inhibitors; Cloprostenol; Double-Blind Method; Drug Therapy, Combination; Female; Glaucoma; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension; Prospective Studies; Quinoxalines; Sulfonamides; Thiazines; Timolol; Travoprost

The primary objective of this study was to determine the intraocular pressure- (IOP) lowering efficacy over two consecutive 24-h periods of travoprost 0.004% ophthalmic solution (Travatan) compared to latanoprost 0.005% (Xalatan) dosed once daily in patients with primary open-angle glaucoma or ocular hypertension.. This was a double-masked trial conducted at the Hospital Clínico San Carlos, Madrid, Spain. The primary objective of this study was to determine the IOP lowering efficacy of travoprost and latanoprost. During the eligibility visit, patients' IOP was measured throughout two consecutive 24-h periods every 4 h. Patients were then randomized to travoprost or latanoprost (one drop at 8 p.m. daily for 2 weeks). Sixty-two patients were randomized (travoprost n = 32; latanoprost n = 30). IOP was measured at week 2 every 4 h throughout two 24-h periods. All measurements were taken in both supine and sitting positions with the aid of Perkins applanation tonometry. Limitations of the study include a small sample size (due to the difficulty in recruiting patients in a study of this type) which enrolled only Caucasian patients and a short study duration. However, with 25 subjects per group, there was at least 90% power to detect a mean IOP change from baseline of 2.9 mmHg and 80% power to detect a difference of 2.5 mmHg between treatments.. Patients on travoprost therapy showed lower mean IOP levels than those on latanoprost. This difference was statistically significant (p < 0.05) at 12, 16, 20, 24, 36, 40, and 48 h after the last dose for the supine position. The mean IOPs in the supine position throughout the first and the second 24-h period of the week 2 visit as well as for the 48-h visit were statistically lower (p < 0.05) for the travoprost group. Adverse events were mild and included hyperemia and corneal staining. Travoprost and latanoprost were both well tolerated.. Mean IOP values were significantly lower for patients on travoprost for the majority of time points in the supine position.

Topics: Aged; Circadian Rhythm; Cloprostenol; Double-Blind Method; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Prostaglandins F, Synthetic; Travoprost

Changes in intraocular pressure (IOP) are known to be related to visual field deficit progression, although multiple models of this relationship exist. In addition, visual functioning is known to affect medical costs. The objective of this study was to project visual field deficit progression and subsequent costs based on clinical trial data.. Using data from a randomized, 12-month, double-masked study, we compared the use of a fixed combination of travoprost 0.004%/timolol 0.5% (T/T) versus a fixed combination of latanoprost 0.005%/timolol 0.5% (L/T) on visual field deficit progression and associated costs. We applied published algorithms linking IOP to visual field changes to calculate the likelihood of visual field deterioration by treatment group. Differences in medical care costs were estimated using guideline-recommended practice patterns, Medicare hospital costs, and published estimates of differences in hospitalization by visual functioning.. Increase in visual field deficit progression rates, increase in annual hospital days per subject, and increase in annual hospital, outpatient, and total costs per subject.. Predicted visual field deficit progression for T/T patients was less than that for L/T patients (not statistically significant). Projected annual medical care costs were 43 dollars lower for T/T vs. L/T patients.. By applying published algorithms linking IOP to visual field changes, this study projected long-term visual field deficit and associated costs. Use of a fixed travoprost/timolol solution may lead to less long-term visual field deficit progression and lower annual medical care costs than a fixed latanoprost/timolol solution.. The use of clinical trial data may limit the applicability of these findings. However, this analysis of direct medical costs only is likely a conservative estimate of the costs associated with visual field deficits.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Cloprostenol; Double-Blind Method; Drug Costs; Drug Therapy, Combination; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Prostaglandins F, Synthetic; Randomized Controlled Trials as Topic; Timolol; Travoprost; Visual Fields

Histological changes of, in particular, collagen and extracellular matrix after administration of topical prostaglandin F(2alpha)(PGF (2alpha)) analogues have been reported. In view of this observation, we investigated the influence of PGF(2alpha) analogues on the central corneal thickness.. In a non-randomized, controlled, cross-sectional study, 403 eyes from 208 consecutive patients were examined: 149 eyes (normals/controls) and 79 with ocular hypertension (OHT), 119 eyes with primary open angle glaucoma (POAG) and 56 eyes with normal tension glaucoma (NTG). One experienced ophthalmologist measured the central corneal thickness (CCT) using ultrasound pachymetry (Tomey AL-2000, sequence of 5 measurements with an SD < 3 microm). The central corneal power was measured with the Zeiss keratometer. Depending on the topical treatment, the patients were classified into 4 groups: A) PGF(2alpha) analogues (n = 78), B) carbonic anhydrase inhibitors (n = 26), C) combination of PGF (2)(alpha) analogues and carbonic anhydrase inhibitors (n = 41), D) none of these drugs (n = 258). T tests and multiple linear regression analyses were used for statistical analysis.. CCT was decreased significantly (p < 0.01 each) in eyes treated with PGF(2alpha) analogues (group A: 529 +/- 34 microM), in comparison with the untreated and non-glaucomatous eyes (part of group D: 542 +/- 35 microM, n = 148), untreated glaucomatous/OHT eyes (part of group D: 563 +/- 37 microM, n = 110), eyes treated with carbonic anhydrase inhibitors (group B: 561 +/- 32 microm) and eyes with a topical application of both PGF (2)(alpha) analogues and carbonic anhydrase inhibitors (group C: 555 +/- 48 microM. No correlation was found between CCT and diagnosis (OHT, POAG, NTG, control), gender, central corneal power, and intraocular pressure in a multivariate analysis.. The present findings suggest that the topical application of prostaglandin F(2alpha) analogues onto the cornea reduces the central corneal thickness significantly. These changes might be attributed to effects of PGF(2alpha) analogues on the extracellular matrix of the corneal stroma via upregulation of matrix metalloproteinases. In clinical practice, corneal thinning under local PGF (2)(alpha) analogue treatment could result in underestimation of intraocular pressure levels as measured by applanation tonometry.

Topics: Acetazolamide; Administration, Topical; Adult; Aged; Carbonic Anhydrase Inhibitors; Cloprostenol; Collagen; Cornea; Corneal Topography; Cross-Sectional Studies; Dinoprost; Drug Therapy, Combination; Extracellular Matrix; Female; Glaucoma; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Prostaglandins F, Synthetic; Sulfonamides; Thiophenes; Travoprost; Ultrasonography

To determine the ability of the Internet-based Spaeth/Richman Contrast Sensitivity (SPARCS) in assessing the change in contrast sensitivity (both central and peripheral) post-treatment with travoprost 0.004%.. This is a prospective observational study.. Data of 62 eyes (33 patients) undergoing treatment for naïve POAG patients were analysed. Patients were followed up for a period of six months after starting topical travoprost (Travatan 0.004%, Alcon), and the change in central and peripheral CS was studied.. Mean total SPARCS score at baseline was 69 ± 10.99, improved to 74.62 ± 9.50 after 6 months of therapy (p: 0.001) in all the glaucoma severity groups. Mean SPARCS score at baseline in mild glaucoma group was 72.05 ± 9.87, in the moderate glaucoma group, it was 62.23 ± 9.2, and in the severe glaucoma group, it was 59.36 ± 11.65. After 6 months of treatment with travoprost, the CS improved to 76.05 ± 8.36 in mild group, 76.69 ± 8.82 in moderate group and 67.18 ± 11.15 in severe group (p value: 0.014). The percentage change in the CS from baseline showed significant improvement in the superotemporal quadrant at 1 month (p value: 0.032), superonasal quadrant (p value: 0.049), inferotemporal quadrant at 3 months (p value: 0.003) and 6 months (p value: 0.039). Inferonasal quadrant was affected most by glaucoma. A statistically significant correlation was seen between total SPARCS score with MD and PSD. Correlation was also seen between the percentage change in CS and average RNFL thickness at 3 and 6 months.. Both central and peripheral CS improve following IOP reduction with travoprost. Change in the CS has a significant correlation with RNFL thickness and the perimetric indices.

Topics: Antihypertensive Agents; Contrast Sensitivity; Glaucoma; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Travoprost; Vision Tests

Benzalkonium chloride (BAK), the most commonly used preservative in anti-glaucoma eye drops, inflicts damage to the ocular surface. A novel anti-glaucoma formulation that avoids the use of BAK has been developed. The aim of this study was to evaluate the cytotoxicity of this formulation and to compare it with an ophthalmic solution containing BAK.. Two different latanoprost eye drops were used: one ophthalmic solution (LSc) containing BAK 0.02% and one ophthalmic nanoemulsion (LNe) with a soft preservative (potassium sorbate 0.18%). Human epithelial conjunctival cells were incubated for 15, 30, and 60 min with either LSc or LNe. The cytotoxicity was determined by MTT assay. Cell death was measured by flow cytometry using annexin V-FITC and propidium iodide.. The values of cell viability and proliferation obtained from cells exposed to LNe were between 80 and 90% relative to the control group, whereas values obtained from cells exposed to LSc were around 30% at all study times (p < 0.05 at 15 and 30 min; p < 0.01 at 60 min). The percentage of viable cells decreased significantly when cells were incubated with LSc compared with cells incubated with LNe at all the study times, while the percentage of cells in late apoptosis/necrosis increased significantly in cells exposed to LSc compared to LNe.. The new latanoprost nanoemulsion is significantly less cytotoxic on human conjunctival cells than LSc. These results suggest that the new formulation might be gentler on the eye surface than currently available BAK-preserved latanoprost solutions.

Topics: Antihypertensive Agents; Benzalkonium Compounds; Cloprostenol; Conjunctiva; Glaucoma; Humans; Latanoprost; Ophthalmic Solutions; Preservatives, Pharmaceutical; Prostaglandins F, Synthetic; Travoprost

Currently, travoprost is a synthetic prostaglandin F

Topics: Drug Carriers; Drug Delivery Systems; Gels; Glaucoma; Humans; Liposomes; Particle Size; Travoprost

The VISIONARY study demonstrated statistically significant intraocular pressure (IOP) reductions with the preservative-free fixed-dose combination of tafluprost 0.0015% and timolol 0.5% (PF tafluprost/timolol FC) in open-angle glaucoma (OAG) or ocular hypertension (OHT) patients, sub-optimally controlled with topical prostaglandin analogue (PGA) or beta-blocker monotherapy. Current subanalyses have examined these data according to the baseline monotherapy.. A European, prospective, observational study included adults (aged ≥ 18 years) with OAG or OHT, who were switched to the PF tafluprost/timolol FC from PGA or beta-blocker monotherapy. Treatment outcomes were reported according to prior monotherapy subgroup: beta-blocker, preserved latanoprost, PF-latanoprost, bimatoprost, tafluprost, and travoprost. Endpoints included the mean change from baseline regarding IOP, conjunctival hyperemia, and corneal fluorescein staining (CFS) at Week 4 and Week 12, and at Month 6.. The subanalysis included 577 patients. All prior monotherapy subgroups demonstrated statistically significant IOP reductions from baseline at Week 4, that were maintained through Month 6 (p < 0.001). Mean (SD) IOP change at Month 6 was 6.6 (4.16), 6.3 (4.39), 5.6 (3.67), 4.9 (2.97), 4.6 (4.39), and 4.7  (3.64) mmHg for prior beta-blocker, preserved latanoprost, PF-latanoprost, tafluprost, bimatoprost, and travoprost subgroups, respectively. The largest IOP change was observed in the preserved latanoprost subgroup for each of the ≥ 20%, ≥ 25%, ≥ 30%, and ≥ 35% IOP reduction categories at Month 6, demonstrating respective reductions of 8.06, 9.20, 10.64, and 11.55 mmHg. CFS was significantly reduced at Month 6 in the prior bimatoprost subgroup (p = 0.0013). Conjunctival hyperemia severity was significantly reduced at each study visit for prior preserved latanoprost users (p < 0.001).. PF tafluprost/timolol FC therapy provided statistically and clinically significant IOP reductions from Week 4 over the total 6-month period, in patients with OAG/OHT, regardless of the type of prior PGA or beta-blocker monotherapy used. Conjunctival hyperemia severity and CFS decreased significantly in prior bimatoprost and preserved latanoprost users, respectively.. European Union electronic Register of Post-Authorization Studies (EU PAS) register number: EUPAS22204.

Topics: Adult; Antihypertensive Agents; Bimatoprost; Drug Combinations; Glaucoma; Glaucoma, Open-Angle; Humans; Hyperemia; Intraocular Pressure; Latanoprost; Ocular Hypertension; Prospective Studies; Prostaglandins A; Prostaglandins F; Timolol; Travoprost

To compare ocular redness score calculated automatically between glaucoma patients and healthy controls, and to assess the associations between this score and both demographical and clinical characteristics.. Glaucoma patients under different topical medications and matched controls were enrolled in this observational cross-sectional study. The Keratograph 5M (Oculus Optikgeräte GmbH) was used to automatically measure 5 redness scores: global; nasal bulbar; temporal bulbar; nasal limbal; temporal limbal. The Student. Ocular redness was significantly higher in patients with glaucoma compared to control subjects. The number of active principles and the use of PAs, CAIs and AAAs were associated with higher redness scores.

Topics: Antihypertensive Agents; Bimatoprost; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Ocular Hypertension; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Travoprost

To investigate the effects of bimatoprost, latanoprost and travoprost on angiogenesis in the chick chorioallantoic membrane (CAM) model in ovo.. Fifty fertilized specific-pathogen-free chick eggs were used in this preclinical, prospective, experimental embryo study. Eggs were randomly distributed into 5 groups of ten eggs. Eggs were placed in the incubator after disinfection of their shells with alcohol and monitored appropriate temperature and humidity. On the 3rd day of incubation, a small window was opened on the eggshell. Bimatoprost in group 1, latanoprost in group 2, travoprost in group 3, bevacizumab in group 4, phosphate-buffered-saline (PBS) used in group 5 was applied by injection to CAM. The sterile film was glued onto the broken part of the shell and the eggs were placed in the incubator again. On the 8th day of incubation, eggs were opened and vascular structures on CAMs were examined. Digital photographs were taken, analysed in the ImageJ open source image processing software and differences between groups were evaluated. Thereafter, VEGF (Vascular endothelial growth factor) levels were measured appropriately in the embryo samples.. All embryos in the prostaglandin groups and the PBS control group were observed to have life signs confirmed by heart rate. In 8 embryos in the bevacizumab group, no life signs were confirmed, while 2 embryos with life signs showed severe hypoplasia. Vascular density, number of vessels and VEGF levels in the bimatoprost, latanoprost and travoprost groups, there were statistically significantly higher than the PBS control group.. This study demonstrates that topical prostaglandin drops increase angiogenesis in the chick CAM model in ovo.

Topics: Animals; Antihypertensive Agents; Bimatoprost; Chick Embryo; Chorioallantoic Membrane; Glaucoma; Humans; Latanoprost; Models, Animal; Neovascularization, Pathologic; Ophthalmic Solutions; Travoprost; Vascular Endothelial Growth Factor A

The distribution of prostaglandin-associated periorbitopathy (PAP) graded using the Shimane University PAP Grading System (SU-PAP) among glaucoma/ocular hypertension subjects using a topical FP or EP2 receptor agonist was reported. A 460 consecutive 460 Japanese subjects (211 men, 249 women; mean age ± standard deviation, 69.9 ± 14.5 years) who had used either a FP agonist (0.005% latanoprost, 0.0015% tafluprost, 0.004% travoprost, 0.03% bimatoprost, or fixed combinations of these) or EP2-agonist (0.002% omidenepag isopropyl) for more than 3 months in at least 1 eye were retrospectively enrolled. Age, sex, prostaglandin, intraocular pressure (IOP) measured by Goldmann applanation tonometry (IOPGAT) and iCare rebound tonometry (IOPRBT), difference between IOPGAT and IOPRBT (IOPGAT-RBT), PAP grade, and PAP grading items were compared among groups stratified by PAP grade or prostaglandins. Of the study patients, 114 (25%) had grade 0 (no PAP), 174 (38%) grade 1 (superficial cosmetic PAP), 141 (31%) grade 2 (deep cosmetic PAP), and 31 (7%) grade 3 (tonometric PAP). The IOPGAT was significantly higher in grade 3 (17.5 ± 5.4 mm Hg) than grades 0 (15.0 ± 5.1 mm Hg, P = .032) and 1 (14.5 ± 4.2 mm Hg, P = .008), and the IOPGAT-RBT was significantly higher in grade 3 (5.8 ± 3.2 mm Hg) than the other 3 grades (1.3-1.9 mm Hg, P < .001 for all comparisons); the IOPRBT was equivalent among the 4 grades. The PAP grade was significantly higher associated with travoprost (2.0 ± 0.8) and bimatoprost (2.0 ± 0.7) than latanoprost (1.0 ± 0.8, P < .001 for both comparisons) and tafluprost (1.0 ± 0.7, P < .001 for both comparisons), but significantly lower associated with omidenepag (0.0 ± 0.0, P < .001 for all comparisons) than the other 4 prostaglandins. Multivariate analyses showed older age (standard β = 0.11), travoprost (0.53, referenced by latanoprost) and bimatoprost (0.65) were associated with higher PAP grades, while tafluprost (-0.18) and omidenepag (-0.73) were associated with lower PAP grades. The PAP graded using SU-PAP reflects the degree of overestimation of the IOPGAT and different severities of PAP among the different prostaglandins. SU-PAP, the grade system constructed based on the underlining mechanisms of PAP, is a simple grading system for PAP that is feasible for use in a real-world clinical situation.

Topics: Age Factors; Aged; Aged, 80 and over; Antihypertensive Agents; Bimatoprost; Cloprostenol; Drug Combinations; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Manometry; Middle Aged; Ocular Hypertension; Orbital Diseases; Prostaglandins F; Prostaglandins, Synthetic; Retrospective Studies; Severity of Illness Index; Sex Factors; Travoprost

Travoprost is a synthetic prostaglandin F2α analogue used in treatment of glaucoma. Due to its water insolubility and oily nature, novel delivery systems need to be developed to enhance its bioavailability, and sustain its release. In the current work, travoprost nanoemulsion was explored as a novel carrier prepared using low energy technique. Results showed that travoprost nanoemulsions exhibited suitable nanodroplet size, zeta potential, pH, refractive index, controlled release, as well as sufficient stability under accelerated conditions. In vivo studies delineated the enhanced absorption of travoprost nanoemulsion compared to the marketed eye drops Travatan®, as proven by the higher C

Topics: Administration, Ophthalmic; Animals; Antihypertensive Agents; Biological Availability; Drug Carriers; Drug Compounding; Emulsions; Feasibility Studies; Glaucoma; Intraocular Pressure; Lipids; Nanoparticles; Ocular Absorption; Ophthalmic Solutions; Rabbits; Travoprost

Lipid DNA nanoparticles (NPs) exhibit an intrinsic affinity to the ocular surface and can be loaded by hybridization with fluorophore-DNA conjugates or with the anti-glaucoma drug travoprost by hybridizing an aptamer that binds the medication. In the travoprost-loaded NPs (Trav-NPs), the drug is bound by specific, non-covalent interactions, not requiring any chemical modification of the active pharmaceutical ingredient. Fluorescently labeled Trav-NPs show a long-lasting adherence to the eye, up to sixty minutes after eye drop instillation. Biosafety of the Trav-NPs was proved and in vivo. Ex vivo and in vivo quantification of travoprost via LC-MS revealed that Trav-NPs deliver at least twice the amount of the drug at every time-point investigated compared to the pristine drug. The data successfully show the applicability of a DNA-based drug delivery system in the field of ophthalmology for the treatment of a major retinal eye disease, i.e. glaucoma.

Topics: Animals; Aptamers, Nucleotide; Containment of Biohazards; Disease Models, Animal; DNA; Drug Delivery Systems; Glaucoma; Humans; Lipids; Mice; Nanoparticles; Rats; Swine; Travoprost

We previously reported the presence of multidrug-resistant staphylococci on the ocular surface of glaucoma patients using prostaglandin analog drops for more than 1 year. Here, we investigated the effect of benzalkonium chloride (BAC) on these multidrug-resistant staphylococci.. No difference was found in the MIC values of prostaglandin analogs. In contrast, the MIC values of BAC were significantly higher for the isolates from the Xa group than for those from the Tz group (2.02 vs. 1.02 µg/mL;. The long-term use of eye drops containing BAC might select BAC-resistant. These findings suggest that the long-term use of eye drops containing BAC might be inappropriate in terms of avoiding antimicrobial resistance.

Topics: Benzalkonium Compounds; Glaucoma; Humans; Ophthalmic Solutions; Staphylococcus epidermidis; Travoprost

The aim of this study was to evaluate the in vivo effects at 3 years of preservative-free tafluprost on corneal health. It was a prospective, masked, study on consecutive patients with a new prescription of preservative-free (PF) tafluprost (naïve-N or switched-S, 44 and 14 patients), and preserved (P) bimatoprost 0.003% or travoprost 0.004% (P-group, 35 patients). A complete ophthalmic examination and an in vivo corneal confocal microscopy evaluation were performed at baseline and every 6 months for 3 years. Ninety-three patients were enrolled, clinical parameters were similar in the groups at baseline, apart from intraocular pressure (IOP) which was lower in the S-group (p = 0.012). Both at baseline and over time, confocal microscopy parameters had different trends. At baseline, keratocyte activation was similar in the three groups (p = 0.43) but over the next months naïve patients treated with PF-tafluprost presented a significant (p = 0.004) reduction in keratocyte activation. Sub-basal nerves tended to increase in patients switched to PF-tafluprost (p = 0.07) while were stable in the other two groups (p = 0.11 in PF and 0.40 in P group). Grade of tortuosity was stable over time in the three groups. Beading-like formations were stable over time for the P- and the PF-group, while significantly increased in the S-group (p = 0.027). Endothelial density values were statistically different at baseline (p = 0.007), they decreased both in PF-group and in S-group (p = 0.048 and 0.001, respectively), while increased in P-group (p = 0.006). Our study is the first to show that a PF-tafluprost formulation does not significantly alter the corneal structures as examined by confocal microscopy after 36 months of topical daily therapy, while improving corneal alterations due to chronic preserved therapies.

Topics: Aged; Bimatoprost; Corneal Keratocytes; Female; Glaucoma; Humans; Intraocular Pressure; Male; Microscopy, Confocal; Middle Aged; Prospective Studies; Prostaglandins F; Travoprost

To assess ocular surface changes in participants using latanoprost with benzalkonium chloride (Xalatan) and travoprost with SofZia (Travatan Z).. In this prospective, open-label, nonrandomized cohort study, participants were classified into two groups: group 1 (n=28) naive to glaucoma therapy, group 2 (n=27) on previous Xalatan monotherapy in both eyes. Both groups started (or continued) Xalatan in the right eye and Travatan Z in the left eye. Baseline, 1-, and 2-month measurements of tear breakup time (TBUT), corneal staining score, conjunctival staining score, conjunctival hyperemia score, tear production, and intraocular pressure were obtained. The Ocular Surface Disease Index questionnaire measured participants' comfort and dryness symptoms. Medication preference was recorded.. Data were collected from 55 participants. Tear breakup time at baseline and 1-month follow-up in group 1 was significantly longer than that of group 2 (P=0.005). At 2 months, there was no significant difference in TBUT between the two groups (P=0.779). Tear production in group 1 at all three time points was significantly higher than group 2 (P<0.05). Conjunctival staining score at 2 months in group 1 was significantly higher than group 2 (P=0.031). There was no significant difference in other parameters between the groups at any other time point. No significant difference in any parameter was found between Xalatan and Travatan Z (intragroup comparison).. Significant differences in ocular surface characteristics were detected between groups, but no significant difference was detected between participants treated with Xalatan and Travatan Z.

Topics: Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Benzalkonium Compounds; Conjunctiva; Cornea; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Preservatives, Pharmaceutical; Prospective Studies; Tears; Travoprost

To investigate, using in vivo confocal microscopy (IVCM), the Meibomian gland (MG) features and conjunctival goblet cell density (GCD) in glaucomatous patients controlled with prostaglandin/timolol fixed combinations (PTFCs).. In this cross-sectional study, 60 white patients were treated with PTFCs, 15 with latanoprost+timolol (L+T) unfixed combination, and 15 controls were enrolled. Patients underwent the Ocular Surface Disease Index questionnaire, tear film breakup time, corneal staining, Schirmer test I, and IVCM of MGs and goblet cells. The main outcome measures were: mean Meibomian acinar density (MMAD) and area (MMAA), inhomogeneity of glandular interstice (InI) and acinar wall (InAW), and GCD.. PTFCs were: latanoprost/timolol (LTFC, 15 eyes), travoprost/timolol (TTFC, 15), bimatoprost/timolol (BTFC, 15), and preservative-free bimatoprost/timolol (PF-BTFC, 15) fixed combinations. Mean time on therapy did not differ among treatments. IVCM documented lower GCD, MMAD, and MMAA (P<0.001), and greater InI and InAW (P<0.05) in glaucoma patients compared with controls. L+T showed worse values compared with PTFCs and PF-BTFC (P<0.05). Preserved PTFCs showed lower MMAD, MMAA, GCD, and greater InI and InAW compared with PF-BTFC (P<0.05) and controls (P<0.001). Differences were not found among PTFCs. InI and InAW significantly correlated with Ocular Surface Disease Index and breakup time (P<0.001), corneal staining (P<0.05), and GCD (P<0.001); GCD correlated with MMAD (P<0.05).. PTFCs were less toxic towards MGs and goblet cells compared with the L+T unfixed combination, with PF-BTFC presenting the most tolerated profile. These findings should be carefully considered given the role of these structures in the induction of the glaucoma-related ocular surface disease.

Topics: Aged; Antihypertensive Agents; Bimatoprost; Case-Control Studies; Cell Count; Conjunctiva; Cross-Sectional Studies; Drug Combinations; Female; Glaucoma; Goblet Cells; Humans; Intraocular Pressure; Latanoprost; Male; Meibomian Glands; Microscopy, Confocal; Middle Aged; Prostaglandins F, Synthetic; Timolol; Tonometry, Ocular; Travoprost

To report the rare incidence of retinal pigment epithelial detachment (RPED) followed by topical travoprost therapy and its subsequent reattachment after cessation of the drug.. A 60-year-old male presented with gradual loss of vision in both eyes and distorted images in right eye. He gave a history of visiting an ophthalmologist a week ago for a routine eye examination. His previous reports revealed best-corrected visual acuity (BCVA) of 6/6, N6 in both eyes with raised intraocular pressures. A diagnosis of primary open-angle glaucoma was made and prescribed topical travoprost 0.004% eye drops. This patient's subsequent visit with diagnosis and treatment is mentioned in this case report.. On examination, his BCVA was found to be 6/36, N12 and 6/6, N6 in right and left eyes, respectively. Optical coherence tomography (OCT) macular scan revealed RPED involving fovea in the right eye and inferotemporal to fovea in the left eye. Patient was advised to discontinue topical travoprost and started brinzolamide 1% eye drops. Ten-day follow-up visit revealed partially resolved RPED by OCT with 6/9 and 6/6 visual acuity in the right and left eyes, respectively. After 1 month, reversal of RPED was noted in OCT with 6/6 vision in both eyes.. Hence, clinicians should be aware of this rare incidence of RPED followed by travoprost therapy. First case of RPED following travoprost therapy and complete reattachment upon withdrawal is reported here in this case report.

Topics: Administration, Topical; Antihypertensive Agents; Fluorescein Angiography; Fundus Oculi; Glaucoma; Humans; Male; Middle Aged; Retinal Detachment; Retinal Pigment Epithelium; Tomography, Optical Coherence; Travoprost; Visual Acuity; Withholding Treatment

To compare pretarsal skin height (PTSH), as proxy indicator of deepening of the upper eyelid sulcus, in children with primary congenital glaucoma (PCG) treated with topical prostaglandin analogues (PGAs) with PTSH in healthy children (control group 1) and children with PCG but not using PGAs (control group 2).. We recruited children with PCG who had been using PGAs for at least 6 months (PCG/PGA group). PTSH in all participants was measured using ImageJ software from photographs taken in a standardized manner. The PTSH was compared for the PCG group and both control groups.. A total of 34 children with PCG and 41 controls (31 in group 1; 10 in group 2) were included. The difference in PTSH between children in the PCG/PGA group and both control groups was statistically significant (mean difference, ≥1.7 mm [P < 0.01]).. The PTSH was significantly greater in children with PCG using PGAs compared to children with PCG not using PGAs and healthy children. Children and their parents should be counseled about lid abnormalities prior to commencing treatment with PGAs.

Topics: Adolescent; Antihypertensive Agents; Bimatoprost; Case-Control Studies; Child; Child, Preschool; Cross-Sectional Studies; Eyelids; Female; Glaucoma; Humans; Latanoprost; Male; Prospective Studies; Prostaglandins, Synthetic; Travoprost

Prostaglandin analogs (PGAs) are commonly used to treat glaucoma because of their powerful intraocular pressure lowering effect. However, various periorbital changes associated with the use of PGAs have been reported. We investigated the incidence of periorbital changes in Korean patients who were treated with PGAs, and analyzed clinical factors associated with superior sulcus deepening.. This study included 58 glaucoma patients who were treated with latanoprost, travoprost, or bimatoprost unilaterally. Face photographs were collected, and periorbital changes such as superior sulcus deepening, eyelid pigmentation, ptosis, lid retraction, dermatochalasis, and redness were evaluated by two oculoplastic specialists. For each patient, the contralateral eye served as a control. The frequency of ptosis, dermatochalasis, pigmentation, erythema, and superior sulcus deepening were analyzed. Demographic and ocular factors were compared between patients who showed superior sulcus deepening and those who did not.. Thirty-one patients (53.4%) showed one or more periorbital changes associated with PGAs. The most common change was superior sulcus deepening (24.1%), followed by eyelid pigmentation (19.0%), eyelid erythema (19.0%), dermatochalasis (10.3%), eyelid retraction (5.2%), and ptosis (3.4%). The age of the patient and the duration of PGA administration was significantly correlated with superior sulcus deepening (p = 0.007, p = 0.002, respectively).. Periorbital changes are frequently seen in patients who use PGAs, and superior sulcus deepening is the most common change in Korean patients. Long-term use of PGAs and old age were associated with superior sulcus deepening.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Bimatoprost; Eyelids; Female; Follow-Up Studies; Glaucoma; Humans; Incidence; Intraocular Pressure; Latanoprost; Male; Middle Aged; Ophthalmic Solutions; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Republic of Korea; Retrospective Studies; Tonometry, Ocular; Travoprost; Young Adult

For primary open angle glaucoma (POAG), laser treatment or surgery is used when the target intraocular pressure (IOP) cannot be achieved by pharmacological agents, such as prostaglandin (PG) analogs; these drugs also have varied effects. We retrospectively reviewed the medical records of 74 POAG patients (74 eyes) whose IOP was inadequately controlled by PG analogs (bimatoprost [13 eyes], latanoprost [34 eyes], tafluprost [11 eyes], and travoprost [16 eyes]) and underwent primary trabeculectomy. The proportion of patients with no recurrent IOP elevation within 24 months post-trabeculectomy was significantly (P < 0.001) lower in the bimatoprost group (31.3%) than in the latanoprost (83.2%), tafluprost (45.5%), or travoprost groups (65.6%). Deepening of the upper eyelid sulcus (DUES) was observed before trabeculectomy in 18 of 74 eyes (24.3%) treated with bimatoprost (9 eyes; 50.0%), latanoprost (3 eyes; 16.7%), tafluprost (1 eye; 5.5%) and travoprost (5 eyes; 27.8%). The proportion of patients with no recurrent IOP elevation up to 24 months post-trabeculectomy was significantly (P < 0.0001) lower in the DUES(+) group (34.7%) than in the DUES(-) group (74.3%). Multivariate stepwise logistic regression analysis, with no recurrent IOP elevation used as dependent variable, and bimatoprost, latanoprost, travoprost, tafluprost, β-blocker, carbonic anhydrase inhibitor, brimonidine, gender, age, preoperative IOP, mean deviation, duration of PG analog use before surgery, and the number of ophthalmic solutions used as independent variables, identified only bimatoprost as a significant independent factor (P = 0.0368). Thus, the outcome of trabeculectomy varied depending on the PG analog used preoperatively, and bimatoprost use was associated with a high risk of recurrent IOP elevation up to 2 years post-trabeculectomy. This may indicate that the incidence of DUES differed with the PG analog used. Patients with glaucoma who are treated with bimatoprost should be monitored for DUES, and when these patients undergo trabeculectomy, the postoperative course of IOP should be followed carefully.

Topics: Aged; Analysis of Variance; Bimatoprost; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Logistic Models; Male; Middle Aged; Multivariate Analysis; Preoperative Care; Prostaglandins F; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Recurrence; Retrospective Studies; Trabeculectomy; Travoprost; Treatment Outcome

Topics: Antihypertensive Agents; Child; Coloboma; Diagnosis, Differential; Glaucoma; Humans; Male; Optic Disk; Optic Nerve; Tomography, Optical Coherence; Travoprost; Ultrasonography

To evaluate the impact of antiglaucoma drugs on the corneal healing process and corneal toxicity.. Four eye drops to treat glaucoma--Xalatan (latanoprost 50 μg/mL; Pfizer), Monoprost (latanoprost 50 μg/mL; Théa Pharma), Taflotan Sine (tafluprost 15 μg/mL; Santen Pharmaceutical Co.), Travatan (travoprost 40 μg/mL; Alcon), and 0.02% benzalkonium chloride (BAC) solution and HyloComod (1 mg/mL sodium hyaluronate; Ursapharm) as positive and negative control were tested regarding corneal irritability and effect on corneal healing. Formulas were tested over 3 days and administered 6 times daily on rabbit corneas cultured on an artificial anterior chamber (the Ex Vivo Eye Irritation Test system). Initially, 4 corneal abrasions (2.5 to 5.7 mm2) were applied. All defects were monitored during drug application by fluorescein stains and photographs. Glucose/lactate concentrations were monitored for corneal metabolic activity evaluation.. For Xalatan and BAC, the corneal erosion size increased from 14.65 to 66.57 mm2 and 14.80 to 87.26 mm2. Travatan and Taflotan Sine did not interfere with corneal healing. Monoprost delayed corneal healing. For Xalatan and BAC, histology showed severe alteration of the superficial cornea. An increase in anterior chamber lactate concentration indicates corneal toxicity for Xalatan, BAC, and Monoprost.. Corneal toxicity of Xalatan is most probably caused by BAC. Monoprost delays corneal healing, which is not well understood. The Monoprost effects could be caused by its additive, macrogolglycerolhydroxystearate 40. This excipient is a known skin irritant, and its concentration is relatively elevated in Monoprost, 50 mg/mL, compared with its active ingredient, latanoprost (0.05 mg/mL).

Topics: Administration, Topical; Animals; Antihypertensive Agents; Benzalkonium Compounds; Cornea; Corneal Injuries; Glaucoma; Intraocular Pressure; Latanoprost; Ophthalmic Solutions; Preservatives, Pharmaceutical; Prostaglandins F; Prostaglandins F, Synthetic; Rabbits; Travoprost; Wound Healing

The aim of this study was to investigate the effects of prostaglandin analogs on blood flow in the ophthalmic artery of clinically healthy rabbits.. Fifty-five clinically healthy New Zealand white rabbits were divided into six groups, and the left eyes were treated for four weeks with the preservative benzalkonium chloride (BAK) only or a topical formulation of different prostaglandin analogs (bimatoprost BAK, tafluprost BAK-free, travoprost BAK, travoprost POLYQUAD, and latanoprost BAK). Color Doppler imaging was performed before and after the treatments. The mean values of the peak systolic velocity (PSV) and end diastolic velocity and the resistive index (RI) were calculated. Statistical analysis was performed to compare the differences pre- and post-treatment for each drug and post-treatment among the drugs.. The prostaglandin analogs did not affect PSV. Bimatoprost BAK, travoprost POLYQUAD, and latanoprost BAK did not change RI. Tafluprost BAK-free and travoprost BAK therapy resulted in similar reductions in RI. No significant differences pre- and post-treatment were found when BAK was administered alone.. The prostaglandin analogs tafluprost BAK-free and travoprost BAK improved blood flow in the ophthalmic artery in healthy New Zealand white rabbits, which suggests that these drugs enhance the prevention of the progression the progression of glaucoma.

Topics: Animals; Antihypertensive Agents; Benzalkonium Compounds; Bimatoprost; Blood Flow Velocity; Female; Glaucoma; Latanoprost; Male; Ophthalmic Artery; Preservatives, Pharmaceutical; Prostaglandins F; Prostaglandins F, Synthetic; Rabbits; Random Allocation; Reference Values; Reproducibility of Results; Travoprost; Ultrasonography, Doppler, Color; Vascular Resistance

To determine whether topical application of travoprost 0.004% induces changes in corneal biomechanical properties affecting intraocular pressure (IOP) values in rabbits.. Both eyes of 10 New Zealand rabbits were measured 3 times with the Ocular Response Analyzer (ORA) before treatment. Each measurement included corneal hysteresis (CH), corneal resistance factor (CRF), corneal-corrected IOP (IOPcc), and Goldmann equivalent IOP (IOPg). A drop of travoprost 0.004% was applied once daily in right eyes for 3 months; left eyes received no treatments. After 3 months of treatment both eyes of all rabbits were again measured 3 times. After complete keratectomy of both eyes, tissues prepared with hematoxylin-eosin stain were analyzed by means of light microscopy.. The mean pre- and post-treatment IOPg, respectively, for right eyes was 9.92 ± 5.64 mm Hg and 7.62 ± 2.99 mm Hg (P = 0.027); IOPcc, 19.81 ± 5.25 mm Hg and 17.79 ± 4.09 mm Hg (P = 0.063); CRF, 1.65 ± 1.63 mm Hg and 2.18 ± 2.50 mm Hg (P = 0.266); and CH, 2.79 ± 1.74 mm Hg and 2.64 ± 2.08 mm Hg (P = 0.72). Mean post-treatment right and left eye IOPg values were, respectively, 7.62 ± 2.99 and 10.30 ± 4.40 (P = 0.002); IOPcc, 17.79 ± 4.09 mm Hg and 20.37 ± 4.32 mm Hg (P = 0.009); CRF, 1.65 ± 1.63 mm Hg and 2.17 ± 2.47 mm Hg (P = 0.274); and CH, 2.79 ± 1.74 mm Hg and 2.54 ± 2.08 mm Hg (P = 0.575). No difference in CH and CRF was observed between treated and untreated eyes.. Post-treatment reduction of IOP in treated eyes was a direct hypotensive effect of travoprost 0.004% and was not affected by changes in corneal biomechanical properties (CH and CRF), resulting in real lower IOP values.

Topics: Animals; Antihypertensive Agents; Biomechanical Phenomena; Cornea; Disease Models, Animal; Glaucoma; Intraocular Pressure; Ophthalmic Solutions; Rabbits; Tonometry, Ocular; Travoprost

To investigate the association between patterns of eye drop prescription and medication usage in patients with glaucoma.. Sixty-seven Japanese patients with glaucoma who were prescribed topical antiglaucoma medications including a prostaglandin analogue bilaterally for >6 months at Nayoro City General Hospital, Nayoro, Japan, were included in the study. A self-administered, 5-item patient questionnaire was administered to determine how patients routinely use medications, including the method of eye drop administration, number of eye drops per instillation, accuracy of eye drop placement, weekly frequency of eye drop application, and their awareness of local side effects. The number of prostaglandin analogue bottles prescribed monthly was compared in each factor.. The mean patient age was 74.4±10.0 years (range, 52 to 95 y; 39 women, 28 men). The mean duration of glaucoma treatment was 4.2±3.2 years (range, 0.7 to 10.6 y). Patients who placed the eye drops outside the eye were prescribed significantly more bottles monthly (P=0.008). The other factors had no significant effect on the number of bottles prescribed monthly.. Patients with glaucoma who used eye drops incorrectly were routinely prescribed additional bottles of eye drops. Ophthalmologists should determine whether patients who request an unusual number of eye drops are using the eye drops correctly.

Topics: Administration, Topical; Aged; Aged, 80 and over; Antihypertensive Agents; Cloprostenol; Drug Prescriptions; Female; Glaucoma; Humans; Intraocular Pressure; Japan; Latanoprost; Male; Medication Adherence; Middle Aged; Ophthalmic Solutions; Prostaglandins F; Prostaglandins F, Synthetic; Surveys and Questionnaires; Travoprost

To determine whether the aqueous levels of matrix metalloproteinases (MMPs) differ between patients with glaucoma treated with topical prostaglandin analogues and normal, nonglaucomatous control patients. Also, to note any difference in MMP levels between latanoprost, travoprost, and bimatoprost that might suggest a difference in efficacy or mechanism of action between these drugs.. Prospective, observational study.. Patients who were scheduled to undergo routine intraocular surgery (phacoemulsification or combined phacotrabeculectomy) as part of their standard clinical care were included. Eighteen eyes of 18 patients with glaucoma using any 1 prostaglandin analogue (latanoprost, travoprost, or bimatoprost) were compared with 8 normal control patients.. This was a multicentre study. Aqueous humour (0.2 mL) was aspirated at the beginning of the intraocular surgery through a clear corneal paracentesis. MMP-2 and -9 were quantified in the aqueous of all participants using enzyme-linked immunosorbent assay.. There was no significant difference in the levels of either MMP-2 (p = 0.216) or MMP-9 (p = 0.552) between the control patients and the patients with glaucoma on prostaglandins. There was no difference in the levels of MMP-2 or -9 between the latanoprost, travoprost, or bimatoprost groups.. The levels of MMP-2 and -9 in aqueous of glaucomatous eyes on topical prostaglandin analogues were the same as those of normal age-matched control patients. This could reflect either a return to normal levels with efficacious treatment or a lack of difference between disease and nondisease states.

Topics: Administration, Topical; Aged; Aged, 80 and over; Amides; Antihypertensive Agents; Aqueous Humor; Bimatoprost; Cloprostenol; Enzyme-Linked Immunosorbent Assay; Female; Glaucoma; Humans; Latanoprost; Male; Matrix Metalloproteinase 2; Matrix Metalloproteinase 9; Middle Aged; Ophthalmic Solutions; Prospective Studies; Prostaglandins F, Synthetic; Travoprost

This study discussed about the influence of local application of glaucoma medications -- travoprost eye drops to patients' tear film function. We selected 24 patients, 45 eyes with primary open-angle glaucoma or intraocular hypertension. All of the patients topically used the travoprost eye drops for one time every night. After and before the pharmacy, we proceeded 1, 2, 3 mo lines symptom score and Schirmer's test (St), corneal fluorescein staining (FL), breakup time of tear film (BUT). Average value of symptom score and FL of all the patients before pharmacy were 1.32 ± 1. 55, 0.42 ± 0.68, and 1, 2, 3mo after pharmacy were respectively 2.68 ± 1.59, 0.96 ± 0.81; 4.97 ± 1.62, 1.46 ± 0.62; 6.21 ± 1.33, 1.88 ± 0.44. Symptom score and FL of 1, 2, 3 mo patients after pharmacy were all prominent higher than it before pharmacy (P=0.00), and it gradually increased. The average value of patients symptom BUT and St before pharmacy were (7.71 ± 0.87s), (8.32 ± 2.63mm /5min) and 1, 2, 3 mo after pharmacy were respectively (6.93 ± 1.17s), (7.69 ± 3. 33mm /5min); (5.48 ± 1.29s), (6.79 ± 2.94mm /5min); (4.33 ± 1.83s), (5.98 ± 3.11mm/5min). BUT and St value after pharmacy were prominent all lower than the level before pharmacy (P=0.00). And it gradually reduced. Short-term use of travoprost eye drops would aggravate the corneal irritation of patients, and decrease the tear film stability and tear secretion.

Topics: Administration, Ophthalmic; Adult; Aged; Cloprostenol; Cornea; Drug Administration Schedule; Female; Glaucoma; Humans; Intraocular Pressure; Lacrimal Apparatus; Male; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Tears; Time Factors; Travoprost; Treatment Outcome; Young Adult

Topics: Antihypertensive Agents; Bimatoprost; Enophthalmos; Female; Glaucoma; Humans; Latanoprost; Magnetic Resonance Imaging; Male; Ophthalmic Solutions; Orbit; Prostaglandins F, Synthetic; Retrospective Studies; Tomography, X-Ray Computed; Travoprost

To investigate the frequency of prostaglandin-associated periorbitopathy among bimatoprost, latanoprost and travoprost users.. Retrospective observational case series.. The study group included 105 patients who were using one of the drugs in one eye for more than 1 month, and the other eye was used as a control.. The frequency of prostaglandin-associated periorbitopathy.. Special care was taken to detect five prostaglandin-associated periorbitopathy findings. Hertel exophthalmometry measurements and colour pictures of the periocular area were taken.. Statistically significant differences were found among the groups regarding the presence of all prostaglandin-associated periorbitopathy findings (P < 0.05). Periorbital fat loss was the most frequent and was observed in nearly all prostaglandin-associated periorbitopathy patients except those who were relatively young. The overall frequency of prostaglandin-associated periorbito pathy was 93.3% in the bimatoprost group, 41.4% in the latanoprost group and 70% in the travoprost group. The frequency of deepening of the upper lid sulcus was 80% in the bimatoprost group, 15.7% in the latanoprost group and 45% in the travoprost group. The frequency of milder changes (the presence of either only periorbital fat loss or dermatochalasis involution or the presence of both) was higher in the latanoprost group (62%) than in the travoprost (35.7%) and bimatoprost (7.1%) groups.. Prostaglandin-associated periorbitopathy is as common as other adverse effects when careful examinations are performed and is more frequent and more severe in bimatoprost users. The loss of the periorbital fat pad is the first sign to occur during the evolution of prostaglandin-associated periorbitopathy, especially in older patients.

Topics: Adolescent; Adult; Aged; Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Eyelid Diseases; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Orbital Diseases; Prostaglandins F, Synthetic; Retrospective Studies; Travoprost; Young Adult

To develop and validate a predictive model to estimate the probability of being nonadherent to topical glaucoma medications.. Prospective cohort study.. Patients being treated with once-daily prostaglandin eye drops.. A predictive model for nonadherence was developed from the Travatan Dosing Aid (TDA) study (n = 196) using stepwise logistic regression. The performance of the TDA-derived model was assessed using a separate cohort of subjects from the Automated Dosing Reminder Study (ADRS; n = 407). The assessment was based on regression coefficients, discrimination, and calibration. We also developed a scoring system from the TDA-derived model to simplify the estimation of risk for clinical use.. Usage of drops was monitored electronically for 3 months in both studies. Adherence was calculated as the percentage of days on which a dose was taken within 4 hours of the average dosing time for that patient. Nonadherence was defined as taking ≤ 75% prescribed doses within a window starting 2 weeks after the baseline visit until 2 weeks before the follow-up visit.. Six factors, including younger age, black race, worse general health status, shorter duration of glaucoma medication therapy, lower self-reported adherence, and admitting to not following doctors' orders, were associated with being nonadherent and were included in the predictive model. The coefficients for the TDA-derived and the ADRS-derived predictive models were similar. The risk scoring system developed from the TDA study had good discrimination (area under the receiver operating characteristic curve of 0.80) and calibration (Hosmer-Lemeshow goodness-of-fit test, P = 0.102) when applied to the ADRS population.. The TDA-derived predictive model for nonadherence performed well in an independent population. A risk scoring system was developed using demographic data and patient responses to 4 questions to provide an estimate of the probability of being nonadherent.

Topics: Administration, Topical; Aged; Antihypertensive Agents; Cloprostenol; Cohort Studies; Drug Monitoring; Female; Glaucoma; Humans; Intraocular Pressure; Male; Medication Adherence; Middle Aged; Models, Statistical; Ophthalmic Solutions; Probability; Prospective Studies; Risk Assessment; ROC Curve; Travoprost

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.

Topics: Amides; Bimatoprost; Cloprostenol; Cross-Sectional Studies; Eyelids; Glaucoma; Humans; Latanoprost; Multivariate Analysis; Prospective Studies; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Skin Abnormalities; Subcutaneous Fat; Travoprost

Eighty-two-year-old patient with a pacemaker using warfarin due to arrhythmia and having an intraocular lens in the right eye, developed spontaneous hemorrhagic choroidal detachment one day after the use of combined preparation of 0.5% timolol maleate and 0.004% travoprost, due to primary open-angle glaucoma. Hemorrhagic detachment was detected by anterior and posterior segment examination, as well as B-scan ultrasonography. After the detachment, excessive increased intraocular pressure was controlled with oral carbonic anhydrase inhibitor, cycloplegic and steroid therapy. After four months, visual acuity was 20/20 and the intraocular pressure was under control with 0.5% timolol maleate and 1% brinzolamide. Controlled reduction of the intraocular pressure should be considered, particularly in older patients under anticoagulant therapy and that had undergone prior ocular surgery.

Topics: Aged, 80 and over; Antihypertensive Agents; Choroid; Choroid Hemorrhage; Cloprostenol; Glaucoma; Humans; Intraocular Pressure; Male; Ophthalmic Solutions; Timolol; Travoprost; Ultrasonography

Prostaglandin F(2)α analogs (PGAs), including latanoprost, travoprost and bimatoprost, the first choice for the pharmaceutical treatment of glaucoma, are gaining more attention on their systemic side effects in recent years. The gastro-intestinal effects are among the most reported adverse effects upon topical application of PGAs. Yet, the underlying mechanism remains to be unknown. In the current study, we performed a molecular genetic analysis on the patient reported by Yu et al. (BMJ Case Rep, 2009), who developed nausea, vomiting and diarrhea after topical application of travoprost and latanoprost, but not bimatoprost, and then speculated that the mechanism underlying the gastro-intestinal distress secondary to PGA topical application should be attributed to their stimulation of smooth muscles of the gastric and intestinal tract via prostanoid receptors. We postulate that the diversified receptor selectivity of various PGAs might mediate their diversified gastro-intestinal effects. To further verificate the speculation, other three glaucoma patients who exhibited different gastro-intestinal responses to different PGA medications were enrolled. The results suggested that the relative expression level of FP receptor, versus EP receptors, might be associated with the severity of gastro-intestinal effects incurred by PGAs. Owing to the differed expression levels of FP receptor, the responses of various patients to different PGAs can be variable.

Topics: Administration, Topical; Aged; Amides; Base Sequence; Bimatoprost; China; Cloprostenol; Diarrhea; Female; Gastrointestinal Tract; Glaucoma; Humans; Latanoprost; Male; Middle Aged; Molecular Sequence Data; Muscle, Smooth; Nausea; Prostaglandins F, Synthetic; Receptors, Prostaglandin; Receptors, Prostaglandin E; Sequence Analysis, DNA; Travoprost; Vomiting

To investigate the toxic-inflammatory effects of prostaglandin analogs on the ocular surface.. Twenty-three rats were divided into four groups. Bimatoprost 0.03% (I), latanoprost 0.005% (II), and travoprost 0.004% (III) were applied during 6 months; a control group (IV) received no treatment. Dysplasia and keratinization were evaluated on the ocular surface. In the subepithelial area, the number of lymphocytes and mast cells were counted morphologically, and collagen staining densities were compared subjectively in groups.. The ratio of keratinization was 3/12 and 1/10, in groups I and II. The lymphocyte cell counts were 1.4 ± 0.19, 2.2 ± 0.39, 2.27 ± 0.33, and 1.87 ± 0.35 (p > .05). The mast cell counts were 2.58 ± 0.5, 5.4 ± 1.1, 5.7 ± 0.58, and 3.0 ± 0.59. They were significantly higher in groups II and III than in group I (p < .05). Mean collagen density scores were 1.00 ± 0.85, 2.00 ± 0.00, and 1,73 ± 0.70. Group II and III scores were higher than group I scores (p < .05).. Latanoprost and travoprost seem to have more toxic-inflammatory effects on the ocular surface than bimatoprost.

Topics: Amides; Animals; Antihypertensive Agents; Bimatoprost; Cloprostenol; Conjunctiva; Conjunctival Diseases; Cornea; Corneal Diseases; Disease Models, Animal; Follow-Up Studies; Glaucoma; Intraocular Pressure; Latanoprost; Male; Ophthalmic Solutions; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Rats; Rats, Wistar; Travoprost

Adherence to long-term treatment regimens for primary open-angle glaucoma holds a challenge for both clinicians and patients. The study aims were to (i) establish the magnitude of travoprost non-adherence using an Electronic Adherence Monitor (EAM), (ii) compare electronic with patient self-reported adherence, and (iii) explore the application of a previously reported method of graphically presenting adherence data to a larger cohort over a longer monitoring period.. A cohort study of patients using travoprost for glaucoma or ocular hypertension was conducted. All participants used an EAM and adherence data were collected prospectively for 2 months. Self-reported adherence was obtained using the Morisky Medication Adherence Scale (MMAS); patients also reported frequency of missed doses. Potential predictors of adherence were collected via a structured interview. EAM-recorded interdose intervals were plotted graphically.. Of 100 patients invited to participate, 98 consented and EAM data were collected successfully from 88 participants. The median EAM adherence score for the cohort was 88.9% (interquartile range: 71.2, 92.2). When dichotomised (≥80%: adherent; <80%: non-adherent), EAM identified 36.7% as non-adherent and MMAS 12.2%. EAM data were used to classify five types of adherence behaviour including a category representing levels of ≥97% maintained by 21% of participants.. EAM revealed good adherence to glaucoma monotherapy but poor agreement with patient self-reported adherence. An adherence category of persistent and exceptionally high adherence to travoprost over a 2-month period was identified.

Topics: Aged; Aged, 80 and over; Antihypertensive Agents; Cloprostenol; Cohort Studies; Female; Glaucoma; Humans; Logistic Models; Male; Medication Adherence; Middle Aged; Self Report; Travoprost

To determine whether the intraocular penetration of travoprost 0.004% is affected by central corneal thickness.. Sixty-four patients who were scheduled for cataract surgery without any other ophthalmologic pathology of significance were enrolled in this study. At 120 min before surgery, one drop of travoprost 0.004% was instilled in the eye to be operated on. At the start of surgery, a sample of aqueous humour was extracted to subsequently determine its AL-5848 concentration. These concentrations were compared among three groups of patients established according to central corneal thickness measurements obtained by ultrasound pachymetry.. Mean AL-5848 concentrations were 3.27±2.03 ng/ml in Group I (CCT<511 microns), 3.27±2.44 ng/ml in Group II (CCT≥511 and ≤574 microns), and 2.73±2.15 ng/ml in Group III (CCT>574 microns), indicating no significant differences among the groups.. We were unable to demonstrate the greater or lesser penetration of travoprost depending on corneal thickness, which could explain differences in patient responses to this drug.

Topics: Adult; Antihypertensive Agents; Aqueous Humor; Cloprostenol; Cornea; Female; Glaucoma; Humans; Male; Travoprost

Examination of the response of the retinal proteome to elevated intraocular pressure (IOP) and to the pharmacological normalization of IOP is crucial, in order to develop drugs with neuroptorective potential. We used a hereditary rat model of ocular hypertension to lower IOP with travaprost and dorzolamide applied topically on the eye surface, and examine changes of the retinal proteome. Our data demonstrate that elevated IOP causes alterations in the retinal protein profile, in particular in high-mobility-group-protein B1 (HMGB1), calmodulin, heat-shock-protein (HSP) 70 and carbonic anhydrase II expression. The changes of the retinal proteome by dorzolamide or travoprost are different and independent of the IOP lowering effect. This fact suggests that the eye drops exert a direct IOP-independent effect on retinal metabolism. Further investigations are required to elucidate the potential neuroprotective mechanisms signaled through changes of HMGB1, calmodulin, HSP70 and carbonic anhydrase II expression in glaucoma. The data may facilitate development of eye drops that exert neuroprotection through direct pharmacological effect.

Topics: Animals; Calmodulin; Carbonic Anhydrase II; Cloprostenol; Disease Models, Animal; Glaucoma; HMGB1 Protein; HSP70 Heat-Shock Proteins; Intraocular Pressure; Ophthalmic Solutions; Peptide Mapping; Proteome; Proteomics; Rats; Retina; Sulfonamides; Thiophenes; Travoprost

To confirm the possible mechanism by which topical prostaglandin antiglaucoma drugs cause a deep superior sulcus.. Among patients who used bimatoprost (Lumigan), latanoprost (Xalatan), or travoprost (Travatan) and who developed a deep upper lid sulcus, 18 eyes of 11 patients (mean age, 58.2 ± 8.9 years) were studied. Seven patients were binocular users of one of the eye drops and four were monocular users. Preaponeurotic orbital fat was obtained, and the mean adipocyte density compared.. In the four monocular users, mean adipocyte density of treated eyes was 1758.21 ± 158.15 cells/mm(2), and that of untreated eyes was 1258.73 ± 127.54 cells/mm(2). This difference was statistically significant (P = 0.04), suggesting that the adipocytes were atrophied in the treated eyes. The mean adipocyte density of the bimatoprost group was 2073.35 ± 184.89 cells/mm(2), that of the travoprost group was 1623.46 ± 218.99 cells/mm(2), and that of the latanoprost group was 1468.20 ± 113.44 cells/mm(2). The densities of the bimatoprost and travoprost groups, but not of the latanoprost group (P = 0.75), were significantly different from that of the untreated group (P < 0.001).. Fat atrophy can be considered a mechanism of upper eyelid sulcus deepening in patients using topical prostaglandin analogs.

Topics: Adipocytes; Adipose Tissue; Amides; Antihypertensive Agents; Atrophy; Bimatoprost; Cell Count; Cloprostenol; Eyelid Diseases; Female; Glaucoma; Humans; Latanoprost; Male; Middle Aged; Ocular Hypertension; Orbital Diseases; Prostaglandins F, Synthetic; Travoprost

Sturge-Weber syndrome (SWS) belongs to a group of disorders known as the phakomatoses. It is characterized by congenital hamartomatous malformations involving the eye, skin, and central nervous system. Several ocular complications are associated with SWS, including glaucoma.. A 66-year-old black man presented with a history of SWS and previously diagnosed glaucoma.. Clinicians need to be aware of cutaneous, neurologic, and ocular complications of this condition. However, glaucoma is the most common ocular complication of SWS.

Topics: Aged; Antihypertensive Agents; Cloprostenol; Glaucoma; Humans; Intraocular Pressure; Male; Optic Nerve; Sturge-Weber Syndrome; Travoprost; Treatment Outcome; Visual Acuity

We investigated the potential cytotoxicity of various topical ophthalmic glaucoma formulations containing different preservatives in cultured human trabecular meshwork (TM) and non-pigmented ciliary epithelial (NPCE) cell lines.. We tested 0.004% travoprost preserved with either 0.015% benzalkonium chloride (BAK), sofZia or 0.001% Polyquad (PQ); and 0.005% latanoprost preserved with 0.020% BAK. We also tested a range of BAK concentrations in balanced salt solution (BSS). TM cells were treated for 10 min at 37°C with solutions diluted 1:10 to mimic the reduced penetration of topical preparations to the anterior chamber. Viability was determined by the uptake of the fluorescent vital dye calcein-AM (n = 6).. BAK solutions (diluted 1:10) demonstrated a dose-dependent reduction in cell viability in both cell types (TM and NPCE). With a 1:10 dilution of 0.020% BAK, there were significantly more living NPCE cells (89 ± 6%) than TM cells (57 ± 6%; p < 0.001). In TM cells, travoprost + BAK had statistically fewer live cells (83 ± 5%) than both travoprost + sofZia (97 ± 5%) and travoprost + PQ (97 ± 6%; p < 0.05). Compared with BSS-treated NPCE cells, travoprost had statistically fewer live cells (p < 0.05) when preserved with BAK (85 ± 16%), sofZia (91 ± 6%) or PQ (94 ± 2%).. These results demonstrate that substitution of BAK from topical ophthalmic drugs results in greater viability of cultured TM cells, the cells involved in the conventional outflow pathway. Cultured NPCE, responsible for aqueous inflow, appear more resilient to BAK.

Topics: Antihypertensive Agents; Benzalkonium Compounds; Cell Survival; Cells, Cultured; Ciliary Body; Cloprostenol; Dose-Response Relationship, Drug; Epithelial Cells; Glaucoma; Humans; Latanoprost; Polymers; Preservatives, Pharmaceutical; Prostaglandins F, Synthetic; Trabecular Meshwork; Travoprost

The combination of anti-glaucoma eye drops is frequently used in clinical treatment, and it is known that the combination can cause corneal damage. Recently, an anti-glaucoma combination eye drops is developed, and the treatment by the combination eye drops is expected to enhance quality of life. However, effects of the combination eye drops on corneal epithelial cell damage have not been clarified. In this study, we investigated the corneal epithelial cell damage of commercially available anti-glaucoma combination eye drops, such as Xalacom® (latanoprost/timolol maleate combination eye drops), Duotrav® (travoprost/timolol maleate combination eye drops) and Cosopt® (dorzolamide hydrochloride/timolol maleate combination eye drops) using the human corneal epithelial cell (HCE-T). The cytotoxicity in Xalacom® was higher than that in Xalatan® (eye drops containing latanoprost) and Timoptol® (eye drops containing timolol maleate), and the benzalkonium chloride (BAC) and timolol maleate were related to cytotoxicity in Xalacom®. The cytotoxicity in Duotrav® and Cosopt® was lower than that in Timoptol®. The Duotrav® is preserved with a non-BAC system (POLYQUAD, polidronium chloride). Therefore, it was suggested that the POLYQUAD related to the low cytotoxicity in Duotrav®. On the other hand, the D-mannitol reduced the cytotoxicity by BAC in this study. This result suggested that the cytotoxicity in Cosopt® was reduced by D-mannitol. The Duotrav® and Cosopt® may be less damaging to the ocular surface of glaucoma patients receiving long-term eye drop therapy in compared with the combination of anti-glaucoma eye drops.

Topics: Antihypertensive Agents; Cells, Cultured; Cloprostenol; Cornea; Drug Combinations; Epithelial Cells; Glaucoma; Humans; In Vitro Techniques; Latanoprost; Mannitol; Ophthalmic Solutions; Polymers; Preservatives, Pharmaceutical; Prostaglandins F, Synthetic; Sulfonamides; Thiophenes; Timolol; Travoprost

To characterize the effects of circadian rhythm, feeding time, age, general anesthesia, and ocular hypotensive compounds on intraocular pressure (IOP) of the Tibetan monkey (Macaca thibetana).. Tibetan monkeys were trained for IOP measurement with the TonoVet® rebound tonometer without sedation or anesthesia. Their circadian IOP fluctuation was monitored every 3 h. Effects of changing the feeding time, general anesthesia, age (2-3 year-old versus 8-15 year-old animals), and various pharmacological agents, such as travoprost, timolol, naphazoline and spiradoline, on IOP were also evaluated.. After behavioral training, conscious Tibetan monkeys were receptive to IOP measurement. The lowest and highest IOP values in a circadian cycle were recorded at 3:00 AM (19.8±0.4 mmHg, mean±SEM, n=12) and noon (29.3±0.9 mmHg), respectively. Changing the feeding time from 11:30 AM to 12:30 PM lowered the noon IOP to 25.1±1.2 mmHg. General anesthesia lowered IOP in these monkeys, while IOP of young and mature animals were similar. Three hours after topical ocular administration, travoprost reduced IOP by 5.2±0.6 mmHg (n=6, p<0.001), and timolol reduced IOP by 2.8±0.7 mmHg (p<0.05). Naphazoline and spiradoline lowered IOP by 4.8 mmHg and 2.5 mmHg (both p<0.001), respectively, 2 h after drug administration.. The circadian IOP fluctuation in conscious Tibetan monkeys and their responses to travoprost, timolol, and other experimental conditions are similar to other primates. These monkeys appear to be a suitable model for glaucoma research.

Topics: Animals; Antihypertensive Agents; Circadian Rhythm; Cloprostenol; Eye; Glaucoma; Intraocular Pressure; Macaca; Male; Models, Animal; Naphazoline; Pyrrolidines; Timolol; Tonometry, Ocular; Travoprost

We investigated the potential short and long-term effects in cultured human trabecular meshwork (TM) cells of various topical glaucoma formulations containing different preservatives.. We tested the fixed combination medications 0.004% travoprost plus 0.5% timolol preserved with either 0.015% benzalkonium chloride (BAK; DuoTrav®), or with 0.001% polyquad (PQ; DuoTrav(®) BAK-free); and 0.005% latanoprost plus 0.5% timolol preserved with 0.020% BAK (Xalacom(®)). Also tested was a range of BAK concentrations (0.001%-0.020%) in balanced salt solution (BSS). Cells were treated for 25 min at 37 °C with solutions diluted 1:10 and 1:100 to mimic the reduced penetration of topical preparations to the anterior chamber. The percentage of live cells was determined immediately after treatment through the uptake of the fluorescent vital dye calcein-AM. To determine any long-term effects, we assayed release of matrix metalloproteinase 9 (MMP-9) and apoptosis 24 h after treatments.. BAK demonstrated a dose-dependent reduction in TM cell viability, ranging from 71±5% live cells at 0.001% BAK (diluted 1:10) to 33±3% live cells at 0.020% BAK (diluted 1:10). Travoprost (0.004%) plus 0.5% timolol preserved with 0.015% BAK had statistically fewer live TM cells (79±7%) than the same preparation preserved with 0.001% polyquad® (PQ; 93±1%; p<0.001). Latanoprost plus timolol preserved with 0.020% BAK (29±9% live cells) was similar to the 0.020% BAK (33±3%) treatment. However, travoprost plus timolol preserved in 0.015% BAK had significantly more live cells (83±12%) than the 1:10 dilution of 0.015% BAK (49±10%). We also found 0.020% BAK (diluted 1:100) resulted in elevated levels of extracellular MMP-9 at 24 h.. These results demonstrate that the substitution of the preservative BAK from topical ophthalmic drugs results in greater in vitro viability of TM cells. Travoprost with timolol, but not latanoprost with timolol, countered some of the toxic BAK effects. BAK treatment appeared to cause elevated levels of MMP-9, a matrix metalloproteinase implicated in the pathogenesis of glaucoma.

Topics: Antihypertensive Agents; Apoptosis; Benzalkonium Compounds; Cell Survival; Cells, Cultured; Cloprostenol; Drug Combinations; Fluoresceins; Glaucoma; Humans; Latanoprost; Matrix Metalloproteinase 9; Polymers; Preservatives, Pharmaceutical; Prostaglandins F, Synthetic; Timolol; Trabecular Meshwork; Travoprost

Glaucoma is one of the leading causes of blindness and visual disability. Few studies have examined persistence and adherence with topical medications in glaucoma patients.. The objective of this study was to compare patient persistence with prostaglandin agonist (PA) monotherapy versus with concomitant adjunctive therapy (AT) in Canada.. Data were obtained from the Québec prescription claims database. Persistence rates were determined for previously treated naive glaucoma patients at 1 year after their index date for use of any of the three available PAs (bimatoprost, latanoprost, and travoprost). Patients who had at least 334 days on their index PA were defined as being persistent during the analysis timeframe. Patient baseline demographics and persistence rates were reported. A logistic regression was used for comparing the PA and PA + AT groups, which incorporated baseline cofounders, such as age and sex, in the analyses.. From an initial cohort of 28 534 patients, 14 893 were identified as naive to glaucoma therapy and had a PA as their index therapy. Of these, 11 197 (75.2%) continued to receive monotherapy and 3696 (24.8%) had an AT added to the PA; 59.0% were females, and the average age was 70.5 ± 11.3 years. Overall, at the end of the first year of therapy, 57.4% of patients were persistent on their index PA; however, a statistically significant difference was observed between the two subgroups, with 54.6% for those receiving PA monotherapy and 65.8% for those receiving PA + AT (p < 0.01) persistent with therapy. On average, 10.5 prescriptions per year were dispensed to persistent patients.. In this Canadian population, persistence rates fall to approximately 60% at the end of the first year of therapy, with patients taking AT being more persistent. Similar persistence analyses are warranted on other populations, and would yield helpful data for conducting economic evaluations of non-persistence.

Topics: Aged; Aged, 80 and over; Amides; Antihypertensive Agents; Bimatoprost; Canada; Chemotherapy, Adjuvant; Cloprostenol; Databases, Factual; Female; Glaucoma; Humans; Insurance; Latanoprost; Logistic Models; Male; Medication Adherence; Middle Aged; Prostaglandin Antagonists; Prostaglandins F, Synthetic; Quebec; Travoprost

The purpose of this study was to report a case hypersensitive to topical bimatoprost and dexamethasone, but with no responsiveness to both latanoprost and travoprost.. A 41-year-old Chinese female presented with unilateral glaucoma secondary to iridocyclitis and long-term use of topical steroid. Trabeculectomy only worked for 9 months and then additional topical glaucoma medications were required to control the intraocular pressure (IOP). All commonly used IOP-lowering medications failed, except for bimatoprost, which significantly lowered the IOP. Topical dexamethasone increased IOP and caused ocular hypertension. Ultrasound biomicroscopy (UBM) was used to evaluate the anterior segment of the affected eye. Genomic DNA was extracted for sequence analysis of gene of prostaglandin F receptor (FP), E receptor 1 (EP1) and 2 (EP2) and myocilin.. UBM revealed cyclodialysis in the patient's affected eye after a single dosage of bimatoprost. The cyclodialysis resolved when IOP was elevated with the topical use of dexamethasone. The dexamethasone-induced high IOP could only be controlled by bimatoprost, whereas the bimatoprost-induced low IOP could only be elevated by topical dexamethasone. Allele C of rs3753380 and allele A of rs3766355 in FP gene and a -224T>C variation of myocilin gene were found in this patient. In addition, a novel heterozygous Cys346Tyr mutation was identified in EP2 gene. No sequence variation was found in EP1 gene.. The hypersensitivity of the affected eye to topical bimatoprost may be a result, at least in part, of cyclodialysis. The sequence analysis results suggested that, besides the polymorphism of FP gene, there might be some other mechanisms underlying the irresponsiveness of this patient to both latanoprost and travoprost. The mechanisms underlying the bimatoprost-induced cyclodialysis might correlate with its receptor selectivity. The -224T>C variation in the myocilin gene may affect the regulation of expression of this gene by dexamethasone.

Topics: Administration, Ophthalmic; Adult; Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Dexamethasone; Female; Gene Expression Regulation; Glaucoma; Glucocorticoids; Humans; Intraocular Pressure; Latanoprost; Polymorphism, Genetic; Prostaglandins F, Synthetic; Receptors, Prostaglandin; Sequence Analysis; Travoprost

To evaluate "in vivo" the effect of topical travoprost on the central corneal thickness (CCT) of rabbit eyes, and the changes in the CCT after acute increases of intraocular pressure (IOP) in these eyes.. This is an interventional, prospective, case-control, masked study. Topical travoprost was applied once daily for one month to the right eye of six New Zealand male rabbits, the left eye of each animal served as control. The baseline CCT and IOP were measured under general anesthesia. After the IOP was stabilized at 15 and 30 mmHg, as registered by direct cannulation of the anterior chamber, CCT measurements were measured again at both pressure levels.. The baseline CCT was thicker in eyes previously treated with travoprost (study group) than in control eyes (p < 0.01). The CCT decreased in both groups when IOP was raised to 15 and 30 mmHg, and there were no statistically significant difference in absolute CCT values between study and control eyes at any of the IOP levels (p = 0.5). However, the amount of CCT decrease from baseline values was greater in eyes previously treated with travoprost (study group) than in control ones, at both 15 and 30 mmHg IOP levels (p = 0.01 and 0.02, respectively).. Rabbit corneas treated with topical travoprost show a different strain response to acute increases in IOP than control eyes.

Topics: Animals; Antihypertensive Agents; Cloprostenol; Cornea; Disease Models, Animal; Dose-Response Relationship, Drug; Follow-Up Studies; Glaucoma; Intraocular Pressure; Male; Ophthalmic Solutions; Prospective Studies; Rabbits; Tonometry, Ocular; Travoprost; Ultrasonography

Uninterrupted use of ocular hypotensive medication by glaucoma patients is important to prevent vision loss, but medication persistence is poor. Efficacy and tolerability influence physicians' decisions and patient persistence, and differences between medications may impact persistence.. To examine differences in physician's decisions to continue, switch, or discontinue therapy across three prostaglandin analogs (PGAs) latanoprost, bimatoprost, and travoprost using claims data supplemented by evaluation of physicians' charted therapeutic decisions.. A year of pharmacy claims data for 6271 patients with a first (index) fill between 5/1/2001 and 11/30/2004 for PGA monotherapy were classified as 'persistent', 'switched', 'restarted', or 'discontinued' with initial PGA use. An analysis of index therapy continuation during the first 2 years reflected chart reviews for 223 patients with PGA monotherapy as the index prescription.. Ten percent of patients had uninterrupted use of the initial PGA alone or in combination for a year. More than half (56%) stopped and then restarted, 16% switched, and 19% discontinued the initial PGA. Patients using latanoprost were more likely to be persistent (11%) compared to bimatoprost (9%) or travoprost (5%; p < 0.0001 overall comparison). Overall, 68% of patients on latanoprost persisted or restarted after a gap compared to 61% for bimatoprost and 58% for travoprost (p < 0.0001). Patient charts demonstrated a parallel pattern in physicians' decisions to continue latanoprost (56%), bimatoprost (45%), and travoprost (40%). Study limitations included the inability to establish causal links between variables, to account for sample use, or to document reasons for patient-driven changes in therapy. The study should be replicated in a more recent database including a larger population.. Uninterrupted use of ocular hypotensive therapy for a full year is relatively rare. Differences in physicians' decisions to continue, switch, or discontinue PGAs were observed in claims data, and parallel trends were observed in patient medical records.

Topics: Adult; Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Continuity of Patient Care; Glaucoma; Humans; Latanoprost; Medication Adherence; Practice Patterns, Physicians'; Prostaglandins F, Synthetic; Retrospective Studies; Travoprost; United States

Prior research has demonstrated that medication persistence (continued acquisition of therapy over time) is far from optimal among patients with glaucoma. The purpose of the present study was to evaluate persistence with prostaglandin analogs among glaucoma patients in the first therapy year using a modification of a previously published technique.. This retrospective analysis of medical and pharmacy claims database included treatment-naive patients dispensed bimatoprost, latanoprost, or travoprost between 1/1/04-12/31/04. "Index agent" was defined as the first agent filled; "index date" was defined as the fill date. Follow-up continued for 358 days. Persistence measures for first therapy year were: (1) whether last fill had sufficient days supply to achieve medication possession at year's end, and (2) number of days for which the index agent was available (days covered). Associations between index agent and medication possession (logistic regression) and days covered (linear regression) were evaluated. Models were adjusted for gender, age, and previous ocular hypertension diagnosis.. 7873 patients met inclusion criteria (bimatoprost, n = 1464; latanoprost, n = 4994; travoprost, n = 1415). Medication possession was 28% and days covered was 131 when using the unadjusted (pharmacy-reported) days supply estimates and rose to 47-48% and days covered to 228-236 days when days supply was imputed. Compared to latanoprost, odds of achieving medication possession at first year's end were 26-34% lower for bimatoprost and 34-36% lower for travoprost (p

Topics: Adult; Aged; Amides; Bimatoprost; Cloprostenol; Databases, Factual; Drug Administration Schedule; Female; Follow-Up Studies; Glaucoma; Humans; Latanoprost; Linear Models; Male; Medication Adherence; Middle Aged; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Retrospective Studies; Travoprost

To identify patterns and rates of adherence with travoprost eye drops using the Travatan dosing aid (TDA) and to present a method for graphically presenting adherence data.. A prospective observational cohort study of patients on travoprost (prostaglandin) monotherapy. Patients were dispensed a TDA and followed up after approximately 3 months of usage. Data were downloaded from the TDA into a computer for analysis. Analysis used inter-dose intervals (the time between each dosing) to look at adherence between days 4 and 75.. In all, 100 patients were invited to participate, 53 agreed and complete TDA data sets were obtained from 37. In total 23 of the complete data sets showed good adherence (dosing within +/-4 h of the agreed dosing time on >80% of occasions), 3 patients discontinued usage before 75 days, 4 showed frequent drug holidays (no dosing for > or =8 days) and 7 frequently missed doses with adherence rates of <60%. Of the 16 patients for whom no TDA data was obtained, 5 were lost to follow-up, 4 had faulty/damaged TDAs, 3 changed medication, 3 preferred not to use the TDA, and 1 was hospitalized.. There were four easily defined patterns of adherence; (1) good adherence; (2) discontinued usage; (3) frequent drug holidays; and (4) frequent missed doses with low adherence rates. A new method for graphically presenting adherence data helps clinicians identify the pattern of usage and is a valuable aid to the overall management of patients on travoprost therapy.

Topics: Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Cloprostenol; Cohort Studies; Drug Monitoring; Female; Glaucoma; Humans; Male; Medication Adherence; Middle Aged; Ophthalmic Solutions; Prospective Studies; Travoprost

Topics: Administration, Topical; Antihypertensive Agents; Cloprostenol; Eyelashes; Female; Glaucoma; Humans; Ophthalmic Solutions; Travoprost

INTRODUCTION|: To investigate potentially adverse effects of different topical glaucoma medications and preservatives on cultured ocular epithelial cells. METHODS|: Confluent cultures of human corneal (10.014 pRSV-T) and conjunctival cells (1-5c-4) were assayed with 100 μL of different glaucoma medications for 25 minutes at 37°C and 5% CO₂. We also tested the preservative sofZia® (Alcon Laboratories, Fort Worth, TX, USA), as well as a range of concentrations of the preservative benzalkonium chloride (BAK; 0.001% to 0.050%). Balanced salt solution was used as the "live" control and a solution containing 70% methanol and 0.2% saponin was used as a "dead" control. The LIVE/DEAD viability/cytotoxicity kit (Invitrogen, Carlsbad, CA, USA) was used to determine the percentage of dead and live cells via ethidium homodimer and calcein fluorescence, respectively. RESULTS|: The toxicity of the prostaglandin analogs latanoprost, tafluprost and travoprost preserved with BAK was similar to the toxicity observed in their respective BAK concentrations. The prostaglandin analog travoprost (0.004%) preserved with the oxidizing preservative sofZia had much greater corneal and conjunctival cell survival than travoprost preserved with BAK. Travoprost (0.004%) containing polyquad also performed statistically better than its BAK-preserved formulation. CONCLUSION|: Ocular surface side effects have previously been demonstrated with chronic, long-term exposure to intraocular pressure-lowering medications containing the common preservative BAK. BAK alone has significant in-vitro cytotoxicity to cultured ocular epithelial cells. Substitution of BAK with polyquad or sofZia resulted in significantly higher percentages of live conjunctival and corneal cells. Further studies are needed to understand the- clinical implications of these findings.

Topics: Administration, Topical; Antihypertensive Agents; Benzalkonium Compounds; Cell Survival; Cells, Cultured; Cloprostenol; Conjunctiva; Dose-Response Relationship, Drug; Epithelium, Corneal; Glaucoma; Humans; Latanoprost; Ophthalmic Solutions; Polymers; Preservatives, Pharmaceutical; Prostaglandins F; Prostaglandins F, Synthetic; Travoprost

The aim of this study was to evaluate the change in hyperemia and intraocular pressure (IOP) in patients who switch from prostaglandin or prostamide to a fixed combination of prostamide and timolol maleate.. A multicenter, longitudinal, noncontrolled, nonrandomized open trial was conducted.. One hundred forty-four patients (282 eyes) were selected: 60 (41.6%) were on travaprost, 51 (35.4%) on bimatoprost, and 33 (22.9%) on latanoprost. All patients included were unable to attain adequate IOP control with monotherapy and had no contraindications to β-blockers.. Patients were treated with a fixed combination of bimatoprost and timolol maleate. Hyperemia was evaluated using a referential table, and IOP was measured at 8:00, 12:00, and 16:00 h both before and after 4 months of treatment.. IOP and hyperemia were compared at 2 time points: pretreatment and after 4 months. The mean of the 3 IOP measurements taken at various points during the day was considered for analysis. Generalized estimating equations were used for repeated measures and intereye dependency adjustments.. Hyperemia and IOP were reduced in all 3 groups, with the same pattern for both eyes. The bimatoprost group had the highest levels of hyperemia before treatment when compared with the latanoprost as well as the travaprost group and had the greatest reduction in hyperemia after treatment (P < 0.01). Regarding IOP, all 3 groups had a significant reduction (P < 0.001), but the bimatoprost group had a lower pretreatment IOP when compared with the travaprost and latanoprost groups.. A significant reduction in hyperemia was found after switching from monotherapy with prostaglandins or prostamide to a fixed combination of prostamide and a β-blocker. IOP reduction was significant after the intervention in all 3 groups.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Drug Combinations; Follow-Up Studies; Glaucoma; Humans; Hyperemia; Intraocular Pressure; Latanoprost; Longitudinal Studies; Prostaglandins F, Synthetic; Time Factors; Timolol; Travoprost

Prostaglandin F2 alpha (PGF2a) analogues including bimatoprost and travoprost are used worldwide, often as first line topical treatments for glaucoma. We present 2 cases of a newly described side effect of both these topical agents in terms of periorbital fat atrophy. This visually noticeable side effect had features demonstrable on MRI scanning. The periorbital fat atrophy is most apparent with uniocular use and both doctors and patients need to be aware of this side effect before commencing treatment. The effects, however, appear to be reversible with treatment cessation.

Topics: Adipose Tissue; Administration, Topical; Aged, 80 and over; Amides; Atrophy; Bimatoprost; Cloprostenol; Female; Follow-Up Studies; Glaucoma; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Orbital Diseases; Prostaglandins, Synthetic; Travoprost

The purpose of this study is to evaluate the intraocular pressure (IOP) -lowering effect and safety of topical travoprost with sofzia and without benzalkonium chloride on Japanese patients with glaucoma. Topical travoprost (0.04%) was used on 39 glaucoma patients with no prior use of topical prostaglandin F2alpha analogues (Beginning group). The IOP, number of conjunctival follicules, degrees of conjunctival hyperemia, and degrees of superficial punctate keratitis (SPK, AD-classification) were determined at the beginning of the treatment and after 1 month and 3 months. 37 other patients who were using 0.005% topical latanoprost were switched to 0.04% topical travoprost and analyzed in the same way (Switched group). For the Beginning group, the IOP was significantly decreased after 3 months (p < 0.0001). The conjunctival follicule score was decreased significantly (p = 0.033). Both the SPK area score and density score for the cases with SPK at the baseline decreased significantly (p = 0.034 and p = 0.024). In the switched group, the IOP was not changed significantly at 3 months after the switch (p = 0.118). Both the conjunctival follicule and hyperemia score were significantly decreased at 3 month (p = 0.0074 and p = 0.0047). The SPK area score for the cases with SPK at the time of switch decreased significantly (p = 0.013). Travoprost with sofzia preservative had an equal effect in reducing the IOP as latanoprost. It had low toxicity on the ocular surface of Japanese glaucoma patients.

Topics: Administration, Topical; Antihypertensive Agents; Benzalkonium Compounds; Cloprostenol; Glaucoma; Humans; Intraocular Pressure; Japan; Keratitis; Preservatives, Pharmaceutical; Prospective Studies; Travoprost

To investigate the relationship between industry- vs nonindustry-funded publications comparing the efficacy of topical prostaglandin analogs by evaluating the correspondence between the statistical significance of the publication's main outcome measure and its abstract conclusions.. Retrospective, observational cohort study.. English publications comparing the ocular hypotensive efficacy between any or all of latanoprost, travoprost, and bimatoprost were searched from the MEDLINE database. Each article was reviewed by three independent observers and was evaluated for source of funding, study quality, statistically significant main outcome measure, correspondence between results of main outcome measure and abstract conclusion, number of intraocular pressure outcomes compared, and journal impact factor. Funding was determined by published disclosure or, in cases of no documented disclosure, the corresponding author was contacted directly to confirm industry funding. Discrepancies were resolved by consensus. The main outcome measure was correspondence between abstract conclusion and reported statistical significance of the publications' main outcome measure.. Thirty-nine publications were included, of which 29 were industry funded and 10 were nonindustry funded. The published abstract conclusion was not consistent with the results of the main outcome measure in 18 (62%) of 29 of the industry-funded studies compared with zero (0%) of 10 of the nonindustry-funded studies (P = .0006). Twenty-six (90%) of the industry-funded studies had proindustry abstract conclusions.. Twenty-four percent of the industry-funded publications had a statistically significant main outcome measure; however, 90% of the industry-funded studies had proindustry abstract conclusions. Both readers and reviewers should scrutinize publications carefully to ensure that data support the authors' conclusions.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Clinical Trials as Topic; Cloprostenol; Conflict of Interest; Drug Industry; Glaucoma; Humans; Intraocular Pressure; Journal Impact Factor; Latanoprost; Periodicals as Topic; Prostaglandins F, Synthetic; Publication Bias; Research Support as Topic; Retrospective Studies; Travoprost

This study aimed to compare the cost effectiveness of travoprost versus a fixed combination of latanoprost/timolol as first-line therapies for ocular hypertension or glaucoma.. Patient charts were extracted from the UK General Practitioner Research Database. Patients with ocular hypertension or glaucoma who received first-line treatment with either travoprost or latanoprost/timolol and were followed up for >6 months were included. Treatment failure was defined as a treatment change or a glaucoma intervention (laser therapy or surgery). Time to treatment failure was compared using a Cox model and adjusted by the propensity score method.. Eligible patients received either travoprost (n=639) or latanoprost/timolol (n=176). Their mean age was 70 years at diagnosis and 48.2% of patients were male. Patient characteristics did not differ significantly between treatment groups. Treatment failure rates at 1 year were 31.3% (travoprost) and 39.4% (latanoprost/timolol) and yielded a hazard ratio for failure in favour of travoprost (0.75; p<0.04) after adjusting for age, sex, co-morbidities and duration of follow-up. Adjusted annual costs of glaucoma management were significantly (p<0.001) less with travoprost (pound215.86) than with latanoprost/timolol (pound327.83).. In everyday practice, travoprost was maintained longer than latanoprost/timolol as first-line therapy for glaucoma. The mean daily costs of travoprost were 50.8% less per patient than those of latanoprost/timolol. Despite adjustments, these results might be confounded, at least partially, by disease severity.

Topics: Aged; Antihypertensive Agents; Cloprostenol; Cost-Benefit Analysis; Databases, Factual; Drug Combinations; Female; Glaucoma; Humans; Latanoprost; Male; Ocular Hypertension; Ophthalmic Solutions; Physicians, Family; Prostaglandins F, Synthetic; Timolol; Travoprost; United Kingdom

Because of the limited ability to perform controlled, randomized studies in children, the safety and effectiveness of topical medications in pediatric glaucoma is sometimes difficult to determine. Although travoprost has been commercially available since 2001, there are no published reports on its use in children. This retrospective study found travoprost to have minimal adverse events in children and to reduce IOP in select cases of pediatric glaucoma.

Topics: Adolescent; Antihypertensive Agents; Child; Child, Preschool; Cloprostenol; Female; Glaucoma; Humans; Infant; Intraocular Pressure; Male; Retrospective Studies; Travoprost; Treatment Outcome

To identify risk factors for poor adherence to topical once daily therapy for glaucoma.. Prospective, observational cohort study.. A total of 196 patients with glaucoma who were being treated with a prostaglandin analog in 1 or more eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007.. Demographics, ocular history, and responses to interview questions about glaucoma knowledge, health beliefs, and drop-taking behaviors were obtained from each patient. All patients used the Travatan Dosing Aid (DA; Alcon Laboratories Inc., Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months, and the data of drop use were downloaded using software provided with the DA. Patients taking 75% of doses.. Risk factors for poor adherence.. Eighty-seven patients (44.4% of the 196 subjects with evaluable data at 3 months) used the DA on 75% or less of the monitored days. In univariate analysis, poorer adherers were more likely to be <50 or >or=80 years of age, to be African American, to report less than excellent health, to report higher amounts of depression, to have lower income, and to be treated at the Scheie Eye Institute. Multivariate analysis (adjusting for education and income) found that age, race/ethnicity, and less than excellent health were associated with poor adherence.. Those who failed to take more than 75% of eyedrop doses were more likely to be African American and to report poor health. Those in the youngest and oldest age groups were less adherent, although this finding was not always statistically significant. Further research into the factors driving these associations and into developing predictive models to assist in screening for low adherence are warranted.. Proprietary or commercial disclosure may be found after the references.

Topics: Age Factors; Aged; Aged, 80 and over; Antihypertensive Agents; Cloprostenol; Drug Monitoring; Ethnicity; Female; Follow-Up Studies; Glaucoma; Health Knowledge, Attitudes, Practice; Humans; Intraocular Pressure; Male; Medication Adherence; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Prospective Studies; Risk Factors; Surveys and Questionnaires; Travoprost

Topics: Antihypertensive Agents; Cloprostenol; Drug Combinations; Glaucoma; Humans; Latanoprost; Ocular Hypotension; Prostaglandins F, Synthetic; Timolol; Travoprost; Treatment Failure

Experimental studies demonstrated an alteration of corneal collagen structure by prostaglandin analogues. The possible effect of the prostaglandin F(2alpha) analogue travoprost 0.004% on the central corneal thickness (CCT) in newly diagnosed glaucoma patients was evaluated.. Consecutive, interventional case series. Seventy-four patients/136 eyes with glaucoma were included in the statistical analysis. All patients received travoprost 0.004% (Travatan(R)) once daily in one or both eyes. CCT was measured by using noncontact optical low-coherence reflectometry prior to the treatment and after 6 and 12 months.. Mean CCT of all treated eyes (n = 136) was 546.71 +/- 34.63 mum at baseline, 535.14 +/- 34.78 mum after 6 months, and 532.38 +/- 34.18 mum after 12 months (ANOVA, P < 0.001). Ninety-five percent of all treated eyes showed a decrease of CCT. CCT reduction mainly developed within the first 6 months of the treatment period. After 12 months, a CCT reduction >30 mum occurred in 5.1% of all treated eyes. There was a significant correlation between the magnitude of corneal thinning and the initial CCT but not between corneal thinning and IOP reductions.. Topical therapy with the prostaglandin derivate travoprost is accompanied by a significant reduction of CCT within one year of treatment. Further clinical studies are needed to evaluate the possible long-term effects of prostaglandins on the CCT of glaucoma patients.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Cloprostenol; Cornea; Female; Glaucoma; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Prospective Studies; Tomography, Optical Coherence; Tonometry, Ocular; Travoprost; Ultrasonography

To develop a model to estimate and compare the cost of changing therapy due to hyperemia in glaucoma patients treated initially either with latanoprost, bimatoprost, or travoprost monotherapy.. Data collected from the HealthCore Integrated Research Database, as part of the Glaucoma Adherence and Persistency Study (GAPS), were used to populate the model. Patients with a documented diagnosis of glaucoma who were newly treated (no ocular hypotensive medication and no glaucoma-related procedure during 6 months before first prescription) with latanoprost, bimatoprost, or travoprost monotherapy were identified. The time horizon for the base-case model was the duration of chart abstraction (mean = 4.1 years); a 3-month model also was developed. Physician-reported rates of hyperemia were obtained from chart reviews of 300 patients. Transition rates reflected events related to reports of hyperemia where a physician-driven change (switch or discontinuation) in therapy was documented. The per-patient direct cost (2008) due to hyperemia-driven change in therapy was calculated as the sum of the cost of the initial prescription plus the cost of the office visit where the patient was evaluated and the decision to change therapy was made. Costs were stratified by whether patients were hyperemia free or discontinued the initial therapy due to hyperemia.. From the sample of 13,977 newly treated patients, 8,743 patients were started on a prostaglandin monotherapy only. Of these, 5,726 received latanoprost, 1,633 were treated with bimatoprost, and 1,384 received travoprost index monotherapy. Across all treatment groups, costs among hyperemia-free patients were US$73.67 versus US$140.02 for those who discontinued the initial prostaglandin due to hyperemia. Per-patient costs were lowest in the group treated initially with latanoprost. For the base-case model, with latanoprost as the reference, total per-patient incremental costs due to hyperemia-driven change in therapy were US$5.92 for bimatoprost and US$5.43 for travoprost. Results were not highly sensitive to increases either in the incidence of hyperemia among latanoprost-treated patients or in the cost of latanoprost.. Hyperemia results in increased overall costs in patients treated with latanoprost, bimatoprost, and travoprost. Treatment with latanoprost is associated with lower hyperemia-related costs than treatment with bimatoprost or travoprost.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Costs and Cost Analysis; Databases, Factual; Drug Costs; Glaucoma; Humans; Hyperemia; Latanoprost; Models, Economic; Prostaglandins F, Synthetic; Retrospective Studies; Travoprost

With the launch of the fixed combination of travoprost 0.004%/timolol 0.5% (trav/tim) in Germany in May 2006, a noninterventional observational study designed as an open-label, multicenter, 6-week trial was initiated in order to evaluate the efficacy and tolerability of this new drug combination in glaucoma patients. Participants were grouped into categories according to previous drug regimens: those on timolol monotherapy; those on prostaglandin analog (PGA) monotherapy; those on concomitant therapy with a PGA and timolol; and those on fixed combinations. Trav/tim was well accepted by the patients, with 87.9% judging the tolerability of the therapy as good, very good, or excellent. Analysis of intraocular pressure (IOP) measurements showed statistically significant IOP decreases in all four categories examined in our study after regimen substitution with fixed-combination trav/tim. Fixed-combination prostaglandin analog/beta-blocker formulations are an attractive therapeutic option due to their strong IOP-lowering efficacy with once-daily dosing. In this study, glaucoma patients who underwent a regimen modification to fixed-combination trav/tim showed further reductions in IOP, irrespective of which selected monoor multiple therapies had been used previously.

Topics: Aged; Chemistry, Pharmaceutical; Cloprostenol; Drug Combinations; Female; Germany; Glaucoma; Humans; Male; Middle Aged; Timolol; Travoprost

Topics: Adrenergic beta-Antagonists; Aged; Antihypertensive Agents; Cloprostenol; Depressive Disorder; Drug Combinations; Glaucoma; Humans; Male; Ophthalmic Solutions; Timolol; Travoprost

Control of intraocular pressure (IOP) is a major factor in avoiding visual impairment related to glaucoma. Both the cost and the effectiveness of therapy should be considered when initiating this lifelong treatment. The aim of this study was to assess the cost effectiveness of travoprost versus latanoprost as single agents for the treatment of glaucoma in France.. Two surveys, one documenting efficacy and the other costs, were used to provide data for a Markov model. The model reproduced the 5-year course of patients receiving a prostaglandin analogue, travoprost or latanoprost, as monotherapy. The effectiveness criterion was fitted with a Weibull distribution from a national study. Transition probabilities and costs per treatment line were extracted from two French observational databases. Bootstrap techniques were implemented to drive the probabilistic sensitivity analyses. The study compared both treatments given once daily as monotherapy to ambulatory patients with primary open-angle glaucoma or ocular hypertension. The main outcome measure was mean time to treatment change (MTTC). Possible treatment changes were the addition of adjunctive medication, treatment substitution, laser therapy or surgery. After laser therapy or surgery, patients could continue with no treatment or proceed to prostaglandin analogue as monotherapy or treatment substitution. IOP was stratified at treatment onset as < or =20, 21-23 and > or =24 mmHg, respectively. All costs were expressed in 2005 euros.. MTTC was 44.3 months for travoprost and 37.8 for latanoprost. Additional 5-year costs for travoprost were euro51, resulting in an incremental cost-effectiveness ratio without treatment change of euro95 per year. Of patients treated with latanoprost, 1.9% underwent laser therapy or surgery, compared with 1.2% of patients treated with travoprost. The results differed with baseline IOP values, such that 55.6%, 53.9% and 50.4% of patients with pretreatment IOP values of < or =20, 21-23 and > or =24 mmHg, respectively, continued to receive travoprost treatment at 5 years, compared with 32.3%, 26.1% and 26.1% of patients, respectively, receiving latanoprost. Thus, incremental cost-effectiveness ratios (ICERs) without treatment change were euro140, euro45 and euro123 per year, respectively.. Travoprost demonstrated a longer effectiveness profile than latanoprost and minimized early treatment changes. The smaller proportion of patients needing a new treatment, laser therapy or surgery virtually compensated for the higher travoprost acquisition cost. Overall, travoprost is cost effective compared with latanoprost, and is most cost effective in patients with pretreatment IOPs between 21 and 23 mmHg.

Topics: Age Factors; Aged; Antihypertensive Agents; Cloprostenol; Cost-Benefit Analysis; Databases, Factual; Drug Costs; Feasibility Studies; Female; France; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Markov Chains; Proportional Hazards Models; Prostaglandins F, Synthetic; Sex Factors; Survival Analysis; Time Factors; Travoprost; Treatment Outcome

Topics: Aged; Antihypertensive Agents; Choroid Diseases; Cloprostenol; Glaucoma; Humans; Intraocular Pressure; Male; Ocular Hypotension; Trabeculectomy; Travoprost

This study compared the toxicity profiles of three antiglaucoma prostaglandin F2alpha analogs, latanoprost, travoprost, and bimatoprost which contain benzalkonium chloride (BAK), with tafluprost, a new preservative-free prostaglandin analog.. IOBA-NHC cells were exposed to BAK-containing prostanoid solutions, their respective BAK concentrations, and preservative-free tafluprost solution for 30 min. Membrane integrity, apoptosis, oxidative stress, and cells morphology were evaluated.. Preservative-free tafluprost resulted in significantly higher membrane integrity and lower pro-apoptotic and pro-oxidative effects than preservative-containing prostaglandin analog preparations.. These results suggest that tafluprost, a new preservative-free prostaglandin analog, has very low or no pro-apoptotic, pro-necrotic, or pro-oxidative effects in vitro compared to preservative-containing formulations.

Topics: Amides; Apoptosis; Benzalkonium Compounds; Bimatoprost; Cell Line; Cell Membrane; Cell Survival; Cloprostenol; Conjunctiva; Dinoprost; DNA; Drug Combinations; Epithelial Cells; Glaucoma; Humans; Latanoprost; Ocular Hypertension; Preservatives, Pharmaceutical; Prostaglandins F; Prostaglandins F, Synthetic; Receptors, Purinergic P2; Receptors, Purinergic P2X7; Superoxides; Travoprost

To develop an alternative method for analysis of patient persistence with prescribed medications using the prostaglandin class of intraocular pressure (IOP)-lowering drugs as a model.. A retrospective study of prescription refill patterns.. Patients with a pharmacy claim for a 2.5 ml bottle of latanoprost, travoprost, or bimatoprost between September 1, 2002 and December 31, 2002 were identified from a retail pharmacy database and were followed up for 12 months. Three separate analyses defined gaps in therapy as spans in excess of 45, 60, or 120 days without a refill for the same medication. Patients were categorized by the number of gaps in therapy and the cumulative length of gaps. A Kaplan-Meier analysis was conducted using a 120-day allowable refill period.. For refill periods of 45, 60, and 120 days, 10.6%, 28.6%, and 77.5% of patients, respectively, had no gaps in therapy, and 32.6%, 53.4%, and 86.5%, respectively, had 30 days or fewer off therapy annually. According to the 45-day threshold analysis, 50.7% of patients had three or more gaps vs 18.5% in the 60-day analysis and none in the 120-day analysis. The Kaplan-Meier curve shows 88.6% and 76.1% of patients were persistent for 120 days and one year, respectively.. Compared with Kaplan-Meier survival curves, the gap analysis approach may better parallel clinical experience with patient persistence, in which patients stop and restart medications for a variety of reasons over time. This method also may help to identify avenues for investigation of lack of persistency among many patients.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Drug Prescriptions; Drug Utilization; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Patient Compliance; Pharmacies; Preferred Provider Organizations; Prostaglandins F, Synthetic; Retrospective Studies; Travoprost

With use of the Wong-Kilbourne derivative Chang conjunctival cell line, this study compared in vitro the ocular toxicity of three topical intraocular pressure (IOP)-lowering agents: travoprost 0.004% containing 0.015% benzalkonium chloride (BAK), travoprost Z 0.004%, a new formulation without BAK, and latanoprost 0.005% containing 0.02% BAK.. Neutral red, Alamar blue, YOPRO-1, and annexin V/7-AAD assays were used to evaluate the effects of the IOP-lowering agents and BAK on cellular viability, membrane integrity, and apoptosis in the conjunctival cell line using microtitration fluorometric analysis and flow cytometry. All assessments were performed in a masked manner.. Assessment of cell viability and membrane integrity revealed a significant effect by latanoprost with BAK or BAK alone but no effect by travoprost Z without BAK or buffer alone (P < 0.0001). Latanoprost with BAK, travoprost with BAK, and BAK alone were cytotoxic in Chang conjunctival cells, whereas no cytotoxicity was observed in cells exposed to travoprost Z without BAK or in cells treated with buffer (P < 0.0001). No increase in apoptosis or necrosis was observed in cells treated with control or travoprost Z without BAK compared with BAK, travoprost with BAK, and latanoprost with BAK (P < 0.0001).. Latanoprost with BAK, travoprost with BAK, and BAK alone have significant cytotoxic effects on human conjunctiva-derived cells and are associated with apoptosis. These effects likely result from BAK used as a preservative. IOP-lowering agents with alternative preservatives instead of BAK will most likely have fewer ocular surface adverse effects than agents containing BAK.

Topics: Annexin A5; Antihypertensive Agents; Apoptosis; Benzalkonium Compounds; Cell Line; Cell Membrane; Cell Survival; Cloprostenol; Conjunctiva; Drug Therapy, Combination; Flow Cytometry; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Necrosis; Preservatives, Pharmaceutical; Prostaglandins F, Synthetic; Travoprost

To determine monthly cost and cost effectiveness of bilateral prostaglandin/prostamide therapy for lowering intraocular pressure (IOP) in patients taking bimatoprost 0.03% (Lumigan, Allergan, Inc.), latanoprost 0.005% (Xalatan, Pfizer, Inc.), or travoprost 0.004% (Travatan, Alcon Laboratories, Inc.).. Drops in five new 2.5-mL bottles were counted and then averaged for each drug. Average retail price was determined by surveys of pharmacies. Drop count, average retail price, average wholesale price, and IOP reduction data were used to compute annual cost, and cost effectiveness (annual cost-per-mm Hg of IOP reduction) of the three drugs.. Drops per 2.5-mL bottle averaged 113 for bimatoprost 0.03%, 84 for latanoprost 0.005%, and 83 for travoprost 0.004%. Average retail cost (2005) per bottle was $69.99 for bimatoprost 0.03%, $61.69 for latanoprost 0.005%, and $66.37 for travoprost 0.004%. The monthly retail cost of bilateral therapy was $37.92 for bimatoprost 0.03%, $44.75 for latanoprost 0.005%, and $49.25 for travoprost 0.004%. Cost effectiveness ranges were $57 to $65 per mm Hg reduction in IOP per year for bimatoprost, 0.03%, $67 to $90 per mm Hg for latanoprost 0.005%, and $74 to $84 per mm Hg for travoprost 0.004%.. Bimatoprost 0.03% had the lowest monthly and annual costs and the greatest cost effectiveness for lowering IOP compared with latanoprost 0.005% and travoprost 0.004%.

Topics: Amides; Bimatoprost; Cloprostenol; Cost-Benefit Analysis; Drug Costs; Economics, Pharmaceutical; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Ocular Hypertension; Prospective Studies; Prostaglandins F, Synthetic; Travoprost

To compare the effectiveness and associated costs of travoprost versus a fixed combination of dorzolamide + timolol as first-line therapy for glaucoma according to data collected by the United Kingdom General Practitioner Research Database (UK-GPRD).. Patients with a diagnosis of ocular hypertension, glaucoma, or who had been treated topically by surgery or laser therapy were selected. Patients starting first-line treatment with travoprost or a fixed dorzolamide + timolol combination were included. Times to treatment failure were compared with an adjusted Cox model.. Cost and treatment failure defined as a prescription change (adding or removing a topical treatment, or initiating laser therapy or surgery).. 56 612 patients were extracted from the database and 39 808 patients received at least one topical prescription for IOP-lowering (intraocular pressure) therapy. Of these, 639 were treated with travoprost and 387 with dorzolamide + timolol, as first-line therapies. No significant difference was found between patient characteristics. Patients were aged 70.0 years and 48.5% were male. At 1 year, treatment failure was experienced by 30.4% of patients receiving travoprost and 49.4% receiving dorzolamide + timolol (p < 0.001). The hazard ratio for failure was 0.79 (p < 0.03) less with travoprost, after adjusting on age, gender, comorbidities and duration of follow-up. Adjusted annual costs of glaucoma management were significantly (p < 0.001) lower with travoprost ( pound198.31) than with dorzolamide + timolol ( pound312.21).. This retrospective costs and consequences analysis study showed that travoprost is more efficient than dorzolamide + timolol as first-line therapy for glaucoma patients. Patients continued longer with first-line treatment when prescribed travoprost at a lower cost.

Topics: Aged; Antihypertensive Agents; Cloprostenol; Cost-Benefit Analysis; Databases, Factual; Drug Combinations; Drug Costs; Female; Glaucoma; Humans; Male; Physicians, Family; Sulfonamides; Thiophenes; Timolol; Travoprost; United Kingdom

Drugs in the lipid class of glaucoma medications, including bimatoprost, travoprost and latanoprost, are effective at lowering intraocular pressure. In addition to clinical efficacy, the budget impact of long-term therapy with each medication is important for patients, physicians and managed-care decision makers to differentiate between the products and make informed decisions regarding the choice of therapy. This study aimed to determine the average number of days between refills for latanoprost, travoprost and bimatoprost, and to estimate the potential effect of differences in refill rates on pharmacy budgets.. In this retrospective database analysis of pharmacy records, the dispensing patterns of patients with glaucoma lipid therapies were obtained. Patients with a pharmacy prescription for the 2.5 mL bottle of latanoprost, travoprost or bimatoprost between September 2002 and December 2002, and receiving continuous treatment defined as having at least one prescription for the same lipid agent and bottle size 1 year later between September 2003 and December 2003, were included in this study. The main outcome measures were mean number of days between refills, mean number of refills, cost per patient per year (based on the average wholesale price [AWP]), and annual refill cost differences between cohorts.. The mean number of days between refills was 46.74 days, 53.65 days and 51.98 days for latanoprost, travoprost and bimatoprost, respectively (p < 0.0001, ANOVA). The mean number of refills per year was 7.1, 6.2 and 6.4 for latanoprost, travoprost and bimatoprost, respectively. Based on this and the AWP, the average cost per patient per year was $US435.16 for latanoprost, $US385.58 for travoprost and $US397.44 for bimatoprost. The cost savings per year if the population of patients using latanoprost (n = 79,820) used bimatoprost or travoprost instead would be approximately $US3.0-$US3.9 million.. A statistically significant difference in mean days between refills was found among the three studied drugs. Latanoprost presented the highest annual cost followed by bimatoprost and travoprost.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amides; Antihypertensive Agents; Bimatoprost; Budgets; Child; Child, Preschool; Cloprostenol; Cost Savings; Cost-Benefit Analysis; Databases, Factual; Drug Costs; Female; Glaucoma; Humans; Infant; Intraocular Pressure; Latanoprost; Lipids; Male; Middle Aged; Pharmacies; Prostaglandins F, Synthetic; Retrospective Studies; Time Factors; Travoprost

To evaluate the accuracy of a prototype electronic device for recording eye drop usage.. Ten volunteers were randomly assigned to one of five usage patterns designed to mimic common patterns of use in glaucoma patients from 100% compliant to 50% compliant. All participants agreed to adhere to a pre-determined "dosing" schedule for 15 days using the monitoring/reminder device to instill artificial tears. Participants also recorded drop usage in a diary. The main outcome measures were device accuracy and reproducibility. Device accuracy was defined as the magnitude of the difference between the diary and device output for three variables: date, number of drops, and instillation time.. Date stamping by the device was 100% accurate. The mean +/- SD time difference between the device and the diary was -2.0 +/- 19.7 minutes when data from all participants was pooled. In seven of the ten participants, the device did not record at least one drop. The mean +/- SD difference in the number of drops recorded by the device minus the diary was 0.16 +/- 0.97 when data from all participants was pooled.. The prototype compliance reminder/monitoring device may underestimate compliance in some patients. The date and time stamping mechanisms were generally accurate and reproducible.

Topics: Antihypertensive Agents; Cloprostenol; Drug Utilization; Glaucoma; Humans; Monitoring, Ambulatory; Ophthalmic Solutions; Patient Compliance; Reproducibility of Results; Travoprost

Cost-effectiveness evaluation of monotherapy with the newer lipid class of intraocular pressure (IOP)-lowering medications in glaucoma and ocular hypertension.. Retrospective pharmacoeconomic analysis.. Analysis included all published studies measuring IOP reduction from untreated baseline with once-daily bimatoprost (Lumigan), latanoprost (Xalatan), or travoprost (Travatan) monotherapy in patients with elevated IOP. Percentage IOP reduction at the final study visit was calculated using the early morning IOP measurement to control for diurnal variation in IOP. Patient-weighted average percentage IOP reductions were computed for each medication. Cost per 2.5-ml bottle was determined using PriceAlert 2005 (February). Cost-effectiveness was defined as monthly cost of medication per patient-weighted average 1% reduction in IOP.. Studies included 951 bimatoprost, 1598 latanoprost, and 765 travoprost patients. The AWP in February, 2005 for a 2.5-ml bottle was 62.10 dollars for bimatoprost, 61.29 dollars for latanoprost, and 62.19 dollars for travoprost. Patient-weighted average IOP reduction was 32.4% for bimatoprost, 29.6% for latanoprost, and 29.0% for travoprost. Calculated cost-effectiveness was 1.92 dollars for bimatoprost, 2.07 dollars for latanoprost, and 2.14 dollars for travoprost. Incremental cost-effectiveness ratio (ICER) analysis showed an incremental cost of 0.29 dollars for each additional 1% IOP reduction provided by bimatoprost over latanoprost. The rank order of the cost-effectiveness of the drugs (bimatoprost > latanoprost > travoprost) was robust in sensitivity analyses to cost and efficacy.. On the basis of AWP and patient-weighted average percentage IOP reduction in published studies, bimatoprost had the most favorable cost-effectiveness among the drugs compared. Cost-effectiveness should be considered along with traditional clinical safety and efficacy measures to make individual and group healthcare decisions.

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Cost-Benefit Analysis; Drug Costs; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Ocular Hypertension; Prostaglandins F, Synthetic; Randomized Controlled Trials as Topic; Travoprost

Topics: Aged; Antihypertensive Agents; Cloprostenol; Female; Glaucoma; Humans; Intraocular Pressure; Travoprost; Uveitis, Anterior

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Cost-Benefit Analysis; Drug Costs; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Ocular Hypertension; Prostaglandins F, Synthetic; Travoprost

To confirm the efficacy of the travoprost treatment during twelve months follow-up in groups of patients: without previous treatment, with different previous anti-glaucomatous treatment, and with different stage of compensation.. The study evaluates the lowering of the intraocular pressure (IOP) in 143 patients (286 eyes). The intraocular pressure was measured by means of aplanation tonometry, before the treatment started, and after 1, 3, 9, and 12 months at 8-9 o'clock a.m. Patients were divided into eight groups according to the previous mono therapy or combined therapy substituted by travoprost mono therapy or its combination. A special group constituted patients with travoprost as a primary treatment.. In the first group, with latanoprost substituted by travoprost, the intraocular pressure decreased by 7% (p < or = 0.0001). In the second group of patients, with travoprost as the primary glaucoma treatment, the intraocular pressure decreased by 22% (p < or = 0.0001). In the third group, the beta-blocker was substituted by travoprost, with 22 % (p < or = 0.0001) decrease of the IOP. In the fourth group, the combined therapy of beta-blocker with latanoprost was substituted by combination of beta-blocker and travoprost and the decrease by 8% (p < or = 0.0001) was significant during the first nine months of the follow-up period, later on, the decrease was not significant. The substitution of the combination of beta-blocker and latanoprost by travoprost mono therapy in the fifth group created only no significant lowering of the IOP during the whole follow-up period. If the travoprost mono therapy substituted the combination of beta-blocker with local carboanhydrase inhibitor in the sixth group, the IOP decreased by 20% (p < or = 0.001). In the seventh group, the combination of the local carboanhydrase inhibitor and latanoprost was substituted by combination of the local carboanhydrase inhibitor with travoprost, the IOP lowering was not significant. On the other hand, in the eighth group, different combinations of antiglaucomatics were substituted by travoprost, and this caused significant lowering of IOP by 20% (p < or = 0.0001). In all cases, the lowest decrease of IOP during the whole follow-up period in the eye with worse compensation is given.. Travoprost lowered effectively the intraocular pressure in 6 out of 8 groups of patients, e.g. in 129 patients (out of 143 patients), the range of lowering was 7-28% bellow the initial level, the follow up period was 12 months. The decrease of the IOP was stable. The drug was well tolerated.

Topics: Cloprostenol; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Male; Prostaglandins F, Synthetic; Travoprost

Topics: Amides; Bimatoprost; Cloprostenol; Glaucoma; Humans; Intraocular Pressure; Lipids; Ocular Hypertension; Patient Selection; Travoprost; Treatment Outcome

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Cost-Benefit Analysis; Drug Costs; Glaucoma; Humans; Latanoprost; Lipids; Ophthalmic Solutions; Prostaglandins F, Synthetic; Travoprost

To examine central corneal mechanical sensitivity (CCMS) after the instillation of latanoprost, travoprost, and bimatoprost.. Nonrandomized interventional study.. Latanoprost was used in 24 patients (43 eyes), travoprost in 21 patients (42 eyes), and bimatoprost in 15 patients (28 eyes). CCMS was examined with the Cochet-Bonnet esthesiometer before the instillation of prostaglandin analogs and then 5 and 30 minutes later. Examination of Schirmer and breakup time (BUT) tests were also performed. Thirty healthy subjects were examined as a control group.. CCMS was significantly reduced at the 5-minute interval for latanoprost (P = .03), travoprost (P = .04), and bimatoprost (P = .04). Differences between the three analogs were statistically not significant. CCMS changes significantly correlated with Schirmer and BUT test scores.. The correlation between CCMS reduction and BUT and Schirmer test scores implies that the use of artificial tears may be considered if prostaglandin analogs are administered.

Topics: Aged; Aged, 80 and over; Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Cornea; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Male; Middle Aged; Ophthalmic Solutions; Prostaglandins F, Synthetic; Sensation; Sensation Disorders; Travoprost

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Dinoprost; Evidence-Based Medicine; Fluorescein Angiography; Glaucoma; Humans; Latanoprost; Lipids; Prostaglandins F, Synthetic; Trabeculectomy; Travoprost

Topics: Aged; Cloprostenol; Exfoliation Syndrome; Female; Glaucoma; Humans; Ophthalmic Solutions; Travoprost; Uveitis, Anterior

Therapeutic decisions (treatment initiation, continuation, change, combination, etc.) based on intraocular pressure (IOP) monitoring require knowledge of both circadian IOP fluctuations and the pharmacological circadian rhythm of the active ingredients. A simple model was applied to data from two clinical trials to estimate the consequences of circadian IOP fluctuations on (1) ocular hypertension diagnosis, (2) therapeutic adjustments, and (3) the daily cumulative effect of marginally low therapeutic differences. A grid for clinical interpretation of the average IOP differences is presented. The probability of an IOP that exceeds the target value for the diagnosis or therapy varied to a large extent throughout the day. IOP was higher in the morning than in the evening. The IOP variance (measured by standard deviation) was an important factor in decision-making, regardless of the IOP value itself. Regular IOP monitoring over the entire day allowed minimization of the time spent above a target value. IOP differences that seemed low when expressed in average values in therapeutic trials could have clinically significant consequences in the practitioner's decisions. The data presented suggest that ocular hypertension diagnosis and therapeutic decisions should be made early in the morning, at least for most patients. In any case, the time of the measurement should be considered in the therapeutic approach.

Topics: Biotransformation; Chronotherapy; Circadian Rhythm; Cloprostenol; Decision Making; Genetic Variation; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Models, Biological; Prostaglandins F, Synthetic; Randomized Controlled Trials as Topic; Travoprost

To compare the ocular hypotensive effect of the commercially available preparations of bimatoprost or travoprost added to latanoprost in monkey eyes with laser-induced unilateral glaucoma.. Four monkeys with unilateral laser-induced glaucoma were used in each treatment group and received drops in the glaucomatous eye only. Intraocular pressure (IOP) was measured hourly for 6 hours, beginning at 9:30 am on day 1 (untreated baseline), days 6 and 7 (single-agent therapy), and days 13 and 14 (2-drug combination therapy). On days 2 through 7, 1 drop of the scheduled single agent was given immediately after the 9:30 am IOP measurement, and on days 8 through 14, the second scheduled drug was given 5 minutes after the first. The following 5 different dosing protocols were studied: latanoprost with bimatoprost added, bimatoprost with latanoprost added, latanoprost with travoprost added, travoprost with latanoprost added, and latanoprost with a second dose of latanoprost added.. There were no statistically significant (P =.95) differences among the mean baseline IOPs in any of the 5 treatment groups. When applied as single agents, latanoprost, bimatoprost, and travoprost all produced significant (P<.05) and equivalent (P =.98) reductions in IOP. The mean +/-SEM maximum reduction (P<.05) from baseline IOP was 7.0 +/- 0.4 mm Hg (20% reduction) with travoprost alone, 6.5 +/- 1.6 mm Hg (18%) with bimatoprost alone, and 7.5 +/- 1.0 mm Hg (22%) with latanoprost alone. The mean +/-SEM maximum additive reductions in IOP were 3.0 +/- 0.6 mm Hg (P<.05) for travoprost added to latanoprost; 2.0 +/- 0.4 mm Hg (P<.05) for latanoprost added to travoprost; 4.8 +/- 1.3 mm Hg (P<.05) for bimatoprost added to latanoprost; 4.3 +/- 0.6 mm Hg (P<.05) for latanoprost added to bimatoprost; and 0.3 +/- 0.5 mm Hg (P>.60) for latanoprost added to itself. The combination of bimatoprost and latanoprost produced a greater (P<.05) lowering of IOP at trough and peak than the combination of travoprost and latanoprost.. Latanoprost, bimatoprost, and travoprost used as monotherapy produced significant and equivalent reductions in IOP in glaucomatous monkey eyes. The IOP effects of the commercial concentrations of bimatoprost or travoprost were additive to that of latanoprost, with bimatoprost showing a greater additive response than travoprost. Clinical Relevance Because treatment with multiple medications is common among patients with glaucoma, determining which glaucoma medications produce an additive ocular hypotensive response when used in combination has practical implications for clinicians.

Topics: Amides; Animals; Antihypertensive Agents; Bimatoprost; Cloprostenol; Disease Models, Animal; Drug Therapy, Combination; Female; Glaucoma; Intraocular Pressure; Latanoprost; Lipids; Macaca fascicularis; Prostaglandins F, Synthetic; Travoprost

Ocular blood flow dysregulation is considered to be a risk factor associated with the optic neuropathy observed in glaucoma patients. The present study evaluates the vasoactive effect of the ocular hypotensive agent travoprost (Travatan) on isolated pig ciliary arteries.. Isometric forces were measured with a myograph system. Quiescent vessels were exposed in a cumulative manner to increasing concentrations (0.1 nM - 0.1 mM) of travoprost ([+]-fluprostenol). Vessels pre-contracted with 100 mM potassium chloride (KCl) or 10 nM endothelin-1 were also exposed in a similar manner to travoprost. Time-control experiments without travoprost were always run in parallel. In quiescent vessels, contractions were expressed in percent of 100 mM KCl-induced contractions. In vessels pre-contracted with endothelin-1, relaxations were expressed in percent of the maximal contraction induced by this peptide, while in those pre-contracted with KCl, relaxations were expressed in percent of the plateau-contraction reached 30 minutes after the application of this drug.. In quiescent vessels, travoprost had no statistically significant vasoconstrictive effect. In KCl- or in endothelin-1 pre-contracted vessels, travoprost had no statistically significant vasorelaxing effect.. Although the clinical relevance of the results of this study for patients treated with travoprost (Travatan) needs to be further investigated, travoprost appears to have no vasoconstrictive properties in isolated porcine ciliary arteries.

Topics: Animals; Ciliary Arteries; Cloprostenol; Dose-Response Relationship, Drug; Glaucoma; In Vitro Techniques; Intraocular Pressure; Optic Neuropathy, Ischemic; Prostaglandins F, Synthetic; Swine; Travoprost; Vascular Resistance; Vasoconstriction

Open-angle glaucoma affects an estimated 33 million individuals worldwide. An intraocular pressure >21 mm Hg in individuals with no evidence of optic nerve damage is termed ocular hypertension, a risk factor for glaucoma that has been estimated to affect as many as 10% of individuals 40 years of age or older.. The purpose of this research was to assess persistency (time on therapy) with prostaglandin analogues in the treatment of glaucoma or ocular hypertension.. This population-based, retrospective cohort study used the Protocare Sciences managed care database, which includes prescription and medical claims data from multiple managed care organizations. Patients 20 years of age or older who initiated therapy with latanoprost, bimatoprost, or travoprost (index drugs) between April 2001 and June 2002 were included. Patients were required to be continuously enrolled in the same plan for the 180 days preceding index prescription fill. Follow-up continued through June 30, 2002. Two outcome measures were analyzed: (1) discontinuation of the index prostaglandin and (2) either discontinuation or change in the index prostaglandin regimen. Changing therapy was defined as switching to or adding another ocular hypotensive agent. Cox regression models were used to compare rate ratios of discontinuation and discontinuation/change. Patient data were censored on termination of insurance coverage or at the end of the study period.. Overall, 7527 patients were prescribed a prostaglandin analogue; 4356 patients met the inclusion criteria (n = 2376, 993, and 987 for latanoprost, bimatoprost, and travoprost, respectively). A total of 58% of patients were women, and 74% were 65 years of age or older. Compared with latanoprost, those treated with bimatoprost were 38% more likely to discontinue and 31% more likely to discontinue/change therapy, and patients treated with travoprost were 36% more likely to discontinue and 29% more likely to discontinue/change therapy (P < 0.001 for each comparison).. Latanoprost-treated patients demonstrated significantly (P < 0.001) greater persistency than did those treated with either bimatoprost or travoprost.

Topics: Administration, Topical; Adult; Aged; Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Cohort Studies; Female; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Male; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Patient Compliance; Prostaglandins F, Synthetic; Prostaglandins, Synthetic; Retrospective Studies; Self Administration; Travoprost

Topics: Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Glaucoma; Humans; Intraocular Pressure; Latanoprost; Lipids; Ocular Hypertension; Prostaglandins F, Synthetic; Travoprost

Topics: Amides; Aminosalicylic Acids; Anti-Ulcer Agents; Antipsychotic Agents; Bimatoprost; Cloprostenol; Cyclohexanes; Drug Approval; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Galantamine; Glaucoma; Gonadotropin-Releasing Hormone; Humans; Hypoglycemic Agents; Insulin; Insulin Glargine; Insulin, Long-Acting; Lipids; Mesalamine; Nateglinide; Nootropic Agents; Phenylalanine; Phenylhydrazines; Piperazines; Thiazoles; Travoprost

Topics: Amides; Bimatoprost; Cloprostenol; Dinoprost; Glaucoma; Humans; Intraocular Pressure; Laser Therapy; Latanoprost; Lipids; Practice Guidelines as Topic; Prostaglandins F, Synthetic; Travoprost; United States

To report angiographically documented cystoid macula edema associated with the use of each of the three newly available ocular hypotensive lipids: unoprostone, travaprost, and bimatoprost.. Observational case series.. Retrospective review of three patients in a clinical practice who had uncontrolled glaucoma on maximal tolerable therapy except for an ocular hypotensive lipids. All three patients also had previous cataract and filtration surgery, and all had an absent or open posterior lens capsule. The patients were informed of the potential risks of cystoid macula edema associated with the use of an ocular hypotensive lipids versus the risks of repeat filtration surgery.. An ocular hypotensive lipids was started in the affected eye in each patient, and the patient was instructed to check visual acuity everyday and report back any change in vision occurred.. Decreased vision of at least two lines caused by angiographically confirmed cystoid macula edema was noted in each of three patients started, respectively, on unoprostone, travaprost, and bimatoprost. The visual acuity returned to baseline, and the cystoid macula edema was angiographically resolved after discontinuation of the ocular hypotensive lipids and the initiation of a topical steroid and non-steroidal anti-inflammatory eyedrops. Until a causal relationship between cystoid macula edema and ocular hypotensive lipids is proved or disproved, caution in their use in high-risk eyes would be prudent.

Topics: Aged; Aged, 80 and over; Amides; Antihypertensive Agents; Bimatoprost; Cloprostenol; Dinoprost; Female; Fluorescein Angiography; Glaucoma; Humans; Intraocular Pressure; Lens Implantation, Intraocular; Lipids; Macular Edema; Male; Phacoemulsification; Retrospective Studies; Trabeculectomy; Travoprost; Visual Acuity