Twenty-four hour intraocular pressure reduction with latanoprost compared with pilocarpine as third-line therapy in exfoliation glaucoma.

Abstract

PURPOSE:

To compare the 24 hour efficacy of latanoprost 0.005% given every evening with that of pilocarpine 4% given four times daily as third-line therapy in patients with exfoliation glaucoma receiving timolol 0.5% and dorzolamide 2% each given twice daily.

METHOD:

We enrolled 30 patients with exfoliation glaucoma not adequately controlled on timolol maleate 0.5% and dorzolamide 2%. Each patient underwent a baseline 24 hour intraocular pressure curve testing at 06:00, 10:00, 14:00, 18:00, 22:00 and 02:00 hours. Patients were randomised to receive either latanoprost 0.005% or pilocarpine 4% for a minimum of 8 weeks and were then crossed over to the opposite therapy. Diurnal curve testing was repeated at the end of each treatment.

RESULTS:

There was a significant decrease from baseline in intraocular pressure at each timepoint for both study medicines (p < 0.016). Latanoprost provided better intraocular pressure control than pilocarpine at daytime measuresments (17.4 vs 19.7 mmHg at 06:00 hours, p < 0.001; 17.8 vs 19.1 mmHg at 10:00 hours, p = 0.04). However, pilocarpine reduced the pressure more than latanoprost at 22:00 hours (18.4 vs 19.5 mmHg, p = 0.016). Overall, the diurnal intraocular pressure was reduced from a baseline of 21.5 +/- 3.7 mmHg to 18.8 +/- 3.1 mmHg on pilocarpine and to 18.0 +/- 3.0 mmHg on latanoprost (p = 0.06). In addition, mean peak pressure was similar between pilocarpine (21.0 +/- 2.9 mmHg) and latanoprost (20.5 +/- 3.8 mmHg) (p = 0.20). Side-effects were similar with the exception of blurred vision, which was only found with pilocarpine (10%). Compliance was more difficult with pilocarpine.

CONCLUSION:

In exfoliation glaucoma, as a third-line adjunctive therapy added to timolol and dorzolamide, latanoprost and pilocarpine have similar diurnal efficacy. However, latanoprost provides a greater morning pressure reduction.

• Authors: A G Konstas, S Lake, A C Maltezos, K T Holmes, W C Stewart
• Journal: Eye (London, England) (Eye (Lond)) Vol. 15 Issue Pt 1 Pg. 59-62 (Feb 2001) ISSN: 0950-222X [Print] England
• PMID: 11318297 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Miotics
• Muscarinic Agonists
• Prostaglandins F, Synthetic
• Pilocarpine
• Latanoprost

Topics

• Aged
• Antihypertensive Agents (therapeutic use)
• Circadian Rhythm (physiology)
• Cross-Over Studies
• Drug Administration Schedule
• Female
• Glaucoma, Open-Angle (drug therapy, physiopathology)
• Humans
• Intraocular Pressure (drug effects, physiology)
• Latanoprost
• Male
• Middle Aged
• Miotics (adverse effects, therapeutic use)
• Muscarinic Agonists (adverse effects, therapeutic use)
• Pilocarpine (adverse effects, therapeutic use)
• Prospective Studies
• Prostaglandins F, Synthetic (adverse effects, therapeutic use)