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This study assessed the clinical risk factors for periorbital dermatitis (PD) after using dorzolamide/timolol eye drops in a total of 1282 glaucoma patients. Both the PD(+) group and the PD(−) group were evaluated using clinical data such as age, sex, dosing duration, presence of benzalkonium chloride (BAK) in the formulation, ocular surgery history (e.g. cataract or glaucoma operations), height, weight, personal history of systemic hypertension, smoking, alcohol consumption, intraocular pressure, best-corrected visual acuity (BCVA), central corneal thickness, axial length, and visual field index (VFI). Univariate analyses showed that shorter dosing duration, higher rate of BAK-included cases, worse BCVA, worse VFI, more systemic hypertension history, and more ocular surgery history were more associated with the PD(+) group than the PD(−) group. The BAK(−) group showed a lower PD rate than the BAK-included group, which was supported by the Kaplan–Meier analysis (log-rank test, p = 0.0014). Multivariate analyses revealed that the probability of PD increased by 8 times if they had a history of ocular surgery and increased by 2.3% when the VFI decreased by 1% (Cox’s hazard regression test, p

Purpose To evaluate topical dorzolamide hydrochloride-timolol maleate as an adjunct therapy to intravitreous anti-vascular endothelial growth factor injections in eyes with retinal vein occlusion resistant to treatment. Methods Retinal vein occlusion patients with a history of persistent macular edema, despite fixed-interval intravitreous anti-vascular endothelial growth factor injections, were enrolled between April 4, 2016, and June 4, 2017. On enrollment, patients were instructed to administer one drop of topical dorzolamide-timolol twice daily for the duration of the study. They were maintained on the same anti-vascular endothelial growth factor drug and same interval between injections as preenrollment for the subsequent two visits. Primary outcome measures were change in central foveal thickness, central subfield thickness, and thickest macular cut at the final study visit. Results Eight patients (8 eyes) were eligible for enrollment and completed the study. There was a significant decrease in central foveal thickness (P = 0.02), central subfield thickness (P = 0.03), and thickest macular cut (P = 0.01) between the enrollment visit and the final visit. There was a decrease in mean (±SD) logarithm of the minimal angle of resolution from 0.52 (±0.35) (20/66, Snellen equivalent) at the enrollment visit to 0.41 (±0.35) (20/51, Snellen equivalent) at the final visit (P = 0.08). Conclusion Topical dorzolamide-timolol may have a beneficial anatomical and functional effect in eyes with macular edema secondary to retinal vein occlusion resistant to treatment.

Background: Glaucoma is one of the most important cause of irreversible blindness in the world. Elevated Intraocular Pressure (IOP) remains the main known risk factor for the development and progression of the disease. The main thera-peutic goal is to preserve visual function by reducing the IOP, which is the key modifiable risk factor. Aim of Study: Is to compare the effect and safety of Dorzolamide/Timolol-Fixed Combination (DTFC) and Bri-monidine/Timolol-Fixed Combination (BTFC), on corneal endothelium after 3 months. Patient and Methods: This comparative non-randomized controlled clinical trial study included 57 eyes of 57 patients which was conducted in Damietta Eye Hospital. Their age ranged from 20-70 years old. The study population was divided into two groups: First group receiving DTFC: Included 27 eyes of 27 patients with open angle glaucoma and second group receiving BTFC included 30 eyes of 30 patients with open angle glaucoma. Result: Show that this adjusted difference between group 1 and group 2 through 3 months follow-up had no statistical significance in all variables such as IOP (p=0.172), CCT (p=0.072) and CD (p=0.406). Conclusion: The patients that received two fixed-combination (dorzolamide/timolol) and (brimonidine/timolol) had no statistically significant effect on CCT and ECD after 3 months from using these drugs.

Background Glaucoma treatments are mostly presented in uni-dose or multi-dose format. A certain number of patients with visual acuity and dexterity problems may have problems in instilling eye drops. Aim To assess patient satisfaction and ease of use of a preservative-free glaucoma treatment (dorzolamide/timolol) in a new and innovative patented multi-dose delivery system. Methods Retrospective, international, multicentre, non-interventional study in 788 adult patients using a multi-dose delivery system for at least 28 days. Results Mean patient age was 68.1 ± 12.1 years. Mean duration of multi-dose delivery system use was 132.1 ± 125.1 days; 66.5% of the patients previously used multi-dose and 33.5% uni-dose delivery systems (n = 734); 78.3% of the patients were satisfied or very satisfied with the multi-dose delivery system. A significant majority (all p ≤ 0.045) of patients with a QuickDash® score between [0 to 25[ (66.4%, n = 211) and [50 to 75[ (81.8%, n = 11) rated multi-dose delivery system as easy or very easy to open and significantly more subjects in the [0 to 25[ (72%) score group rated multi-dose delivery system as being better or much better than their previous device (n = 211). Significantly (all p Conclusion The tested multi-dose delivery system was highly accepted. It is, therefore, suitable for glaucoma patients with decreased visual acuity and/or dexterity problems. Further studies may be necessary to assess the easiness of use of this easy-to-grip delivery system.

To compare the efficacy, patient-reported satisfaction, and safety of preservative-free (PF)-tafluprost, PF-dorzolamide/timolol and preservative-containing (P)-latanoprost in Korean glaucoma patients with ocular surface disease (OSD). In a multicenter, prospective, interventional, non-randomized, controlled 12-week trial, 107 eligible patients received PF-tafluprost (n = 37), PF-dorzolamide/timolol (n = 34), or P-latanoprost eye drops (n = 36). Outcomes included changes from baseline in OSD Index (OSDI) scores (primary endpoint), intraocular pressure (IOP), and patient-reported treatment satisfaction, and safety at 12 weeks. At 12 weeks, the mean total OSDI and subdomain (dry eye symptoms, visual-related function, environmental triggers) scores significantly improved from baseline with PF-tafluprost and PF-dorzolamide/timolol, but not with P-latanoprost. Significantly more PF-tafluprost than P-latanoprost recipients reported ‘highly improved/improved’ satisfaction (no significant difference between PF-dorzolamide/timolol and P-latanoprost). IOP changes were comparable among all three treatment groups. No new safety concerns were observed. PF-tafluprost and PF-dorzolamide/timolol showed statistically and clinically significant reductions in OSDI compared with P-latanoprost in Korean glaucoma patients with OSD.

The purpose of this study was to report a case of acute corneal endothelial decompensation caused by a topical dorzolamide/timolol fixed combination (DTFC) after Descemet stripping automated endothelial keratoplasty.A 75-year-old woman who was referred to our hospital with a chief complaint of visual disturbance in the right eye after cataract surgery. Anterior segment optical coherence tomography identified an extensive defect in Descemet membrane. The patient subsequently underwent uneventful Descemet stripping automated endothelial keratoplasty surgery for persistent corneal edema. Two weeks after surgery, she had been prescribed topical DTFC twice daily to control elevated intraocular pressure. On the day she started using the eye drops, the patient noticed an acute deterioration of visual acuity. Severe corneal edema was detected at follow-up 5 days later.The topical DTFC was stopped immediately. Thereafter, the corneal edema improved gradually, and there was a reduction in corneal thickness.Topical DTFC should be used with caution after corneal endothelial transplantation because of the possibility of iatrogenic corneal endothelial dysfunction.

To evaluate the efficacy of adjuvant topical dorzolamide-timolol in patients with neovascular age-related macular degeneration unresponsive to anti-vascular endothelial growth factor therapy.This retrospective, interventional study included 15 patients with neovascular age-related macular degeneration refractory to anti-vascular endothelial growth factor. Patients used topical dorzolamide-timolol twice daily in the neovascular age-related macular degeneration eye and received anti-vascular endothelial growth factor therapy at each visit, with the same fixed interval and agent as before the addition of dorzolamide-timolol. Central macular thickness, maximal subretinal fluid height, and maximal pigment epithelial detachment height were measured at baseline and every visit.The mean follow-up period was 17.2 ± 5.5 weeks. The mean central macular thickness decreased from 383.5 μm at baseline to 298.3 μm at the final visit (P = 0.041). The mean maximal subretinal fluid height decreased from 105.0 μm at baseline to 58.3 μm at the final visit (P = 0.021). Complete resolution of subretinal fluid was observed in 3 of 11 subretinal fluid-type eyes. There was no significant change in the maximal pigment epithelial detachment height. The mean logarithm of the minimum angle of resolution visual acuity decreased from 0.61 (20/81 Snellen) at baseline to 0.66 (20/91 Snellen) at final visit, which was not significant (P = 0.314). The mean intraocular pressure decreased significantly from 14.9 mmHg at baseline to 12.3 mmHg at the final visit (P = 0.005).The use of adjuvant topical dorzolamide-timolol was effective in decreasing central macular thickness and subretinal fluid in patients with neovascular age-related macular degeneration refractory to continual fixed-interval intravitreal anti-vascular endothelial growth factor therapy, but did not result in functional improvement in this short-term study.

Background: Primary open-angle glaucoma (POAG) is a very common disorder, and it is the second leading cause that results in blindness worldwide after cataracts. Previous studies have reported that dorzolamide/timolol-fixed combination (DTFC) can be used in treating POAG. However, there are still inconsistent results. Thus, this study will systematically investigate the efficacy and safety of DTFC on POAG. Methods: A comprehensive search will be carried out in Cochrane Library, MEDLINE, EMBASE, CINAHI, ACMD, China National Knowledge Infrastructure, and WANGFANG database from origin to the present. There are no limitations related to the language and publication status. Only randomized controlled trials that assessed the efficacy and safety of DTFC for the treatment of POAG will be included. Two researchers will independently undertake record selection, data extraction, and study quality assessment. Any divisions will be solved by discussion with a third researcher. We will perform statistical analysis using RevMan 5.3 software Results: This study will summarize the present evidence to identify the efficacy and safety of DTFC in treating POAG through mean intraocular pressure, best corrected visual acuity, contrast sensitivity, bioelectric activity of the retina, rate of progression of glaucoma, quality of life, and adverse events. Conclusions: The results of this study will provide evidence of DTFC for the treatment of POAG. Systematic review registration: INPLASY202040120.

The key clinical attributes of preserved dorzolamide/timolol fixed combination (DTFC) and the emerging potential of preservative-free (PF) DTFC are reviewed with published evidence and clinical experience. The indications and role of DTFC in current glaucoma management are critically discussed. Preserved DTFC became the first intraocular pressure (IOP)-lowering fixed combination (FC) approved by the US Food and Drug Administration (FDA) and remains one of most commonly used medications worldwide. The pharmacological properties of DTFC reflect those of its two time-tested constituents, i.e., the carbonic anhydrase inhibitor dorzolamide and the non-selective beta-blocker timolol. In regulatory studies DTFC lowers IOP on average by 9 mmHg (32.7%) at peak and by 7.7 mmHg (27%) at trough. In trials DTFC shows equivalence to unfixed concomitant therapy, but in real-life practice it may prove superior owing to enhanced convenience, elimination of the washout effect from the second drop, improved tolerability, and better adherence. PF DTFC became the first PF FC approved, first in unit-dose pipettes, and more recently in a multidose format. Cumulative evidence has confirmed that PF DTFC is at least equivalent in efficacy to preserved DTFC and provides a tangible clinical benefit to patients with glaucoma suffering from ocular surface disease by improving tolerability and adherence. Finally, we identify areas that warrant further investigation with preserved and PF DTFC.

Background: Primary open-angle glaucoma (POAG) is a very common disorder, and it is the second leading cause that results in blindness worldwide after cataracts. Previous studies have reported that dorzolamide/timolol-fixed combination (DTFC) can be used in treating POAG. However, there are still inconsistent results. Thus, this study will systematically investigate the efficacy and safety of DTFC on POAG. Methods: A comprehensive search will be carried out in Cochrane Library, MEDLINE, EMBASE, CINAHI, ACMD, China National Knowledge Infrastructure, and WANGFANG database from origin to the present. There are no limitations related to the language and publication status. Only randomized controlled trials that assessed the efficacy and safety of DTFC for the treatment of POAG will be included. Two researchers will independently undertake record selection, data extraction, and study quality assessment. Any divisions will be solved by discussion with a third researcher. We will perform statistical analysis using RevMan 5.3 software Discussion: This study will summarize the present evidence to identify the efficacy and safety of DTFC in treating POAG through mean intraocular pressure, best corrected visual acuity, contrast sensitivity, bioelectric activity of the retina, rate of progression of glaucoma, quality of life, and adverse events. The results of this study will help to determine whether DTFC is effective and safety for the treatment of POAG.Systematic review registration: PROSPERO CRD42020170531.

Importance Some eyes with neovascular age-related macular degeneration (AMD) have persistent exudation despite frequent intravitreal anti–vascular endothelial growth factor (VEGF) injections. Adjuvant therapies that further reduce edema may improve vision outcomes. Objective To compare the short-term effect of topical dorzolamide-timolol vs placebo in eyes with neovascular AMD that have persistent exudation following intravitreal anti-VEGF injections. Design, Setting, and Participants Randomized placebo-controlled clinical trial with enrollment from March 1, 2017, through October 30, 2018. Multicenter trial at 4 clinical sites in the United States. Sixty-three patients with neovascular AMD who had persistent exudation despite intravitreal anti-VEGF injections at 4-week, 5-week, or 6-week intervals. Interventions Patients were randomized to use dorzolamide-timolol or artificial tears for the study duration. They continued to receive the same anti-VEGF drug at the same interval as the 2 visits before enrollment for 3 additional study visits. Main Outcomes and Measures The primary outcome measure was change in mean central subfield thickness on optical coherence tomography from baseline to visit 3 (approximately 3 months). Secondary measures included change in mean maximum subretinal fluid height, mean maximum pigment epithelial detachment height, and mean visual acuity (VA). Results This trial included 52 patients. All 27 patients (100%) assigned to dorzolamide-timolol and 23 of 25 (92%) assigned to placebo were analyzed for the primary outcome. Mean (SD) age was 78.4 (7) years, and 34 of 50 patients (68%) were women. Mean (SD) injections were 20.5 (14) (range, 4-58) before enrollment. Mean (SD) baseline logMAR VA was 0.361 (0.26) (approximate Snellen equivalent, 20/50). Comparing the dorzolamide-timolol with placebo group from baseline to visit 3, mean (SD) change in central subfield thickness (primary outcome) was −36.6 (54) μm vs 1.7 (52.3) μm (difference, 30.8; 95% CI, 0.3-61.3;P = .04); secondary outcomes: maximum PED height was −39.1 (65) μm vs 1.1 (16) μm (difference, 39.6; 95% CI, 9.6-69.6;P = .01) and change in VA from baseline to visit 3 was −2.3 (5) vs 0.3 (1) letters (difference, 2.6 letters; 95% CI, −1.9 to 7.1 letters;P = .78). Conclusions and Relevance These findings suggest use of dorzolamide-timolol in patients with neovascular AMD with persistent exudation resulted in anatomic but not visual acuity improvements compared with placebo at approximately 3 months. Additional clinical trials with longer follow-up and larger sample sizes presumably would be needed to determine the role, if any, of dorzolamide-timolol in neovascular AMD. Trial Registration ClinicalTrials.gov Identifier:NCT03034772

WOS: 000369596300007 PubMed ID: 26853174 In our study we aimed to evaluate the short-term effects of dorzolamide/timolol on ocular perfusion pressure and retrobulbar blood flow in patients with pseudoexfoliative glaucoma (PXG). This prospective observational cross-sectional study enrolled 22 eyes of 22 newly-diagnosed patients with PXG in a single center. All of the patients received a fixed combination of dorzolamide/timolol. Besides routine ophthalmologic examination, the retrobulbar hemodynamic parameters in the ophthalmic artery, central retinal artery, and short posterior ciliary arteries were measured in all participants at baseline and the 3rd month using color Doppler imaging. The mean intraocular pressure (IOP) was 22.3 +/- 2.1 mmHg at baseline and reduced to 17.4 +/- 2.3 mmHg at the 3rd month (p < 0.05). None of the retrobulbar parameters, except peak systolic velocity and resistive index in temporal short posterior ciliary arteries, changed significantly on therapy with dorzolamide/timolol fixed combination when the results were analyzed at Month 3. The drug significantly decreased the peak systolic velocity (p = 0.044) and reduced the resistive index in 0.04 units, 95% confidence interval 0.03-0.05, (p < 0.001) in the temporal short posterior ciliary arteries. This study reports that the retrobulbar hemodynamics might be affected less than expected by dorzolamide/timolol fixed combination in patients with PXG although the reduction of IOP was statistically significant.

Purpose: To evaluate and compare the toxic effects of eyedrops containing a fixed combination of 2.0% dorzolamide and 0.5% maleate timolol with or without preservatives on rabbit corneal endothelium. Methods: This study was performed with 22 eyes of New Zealand white rabbits. Dorzolamide/timolol eyedrops with preservative (Cosopt group) or without preservative (Cosopt-S group) were diluted with a balanced salt solution at a 1 : 1 ratio. We injected 0.1 mL of diluted Cosopt into the anterior chamber of left eyes and an equal volume of diluted Cosopt-S into the anterior chamber of right eyes. Corneal thickness, corneal haze, and conjunctival injection were measured before and 24 hours after treatment. Endothelial damage was compared between both eyes by vital staining (alizarin red/trypan blue staining), live/dead cell assay, TUNEL assay, and scanning electron microscopy. Results: Corneal endothelial damage was severe in the Cosopt group. Cosopt-treated eyes exhibited remarkable corneal edema and prominent apoptosis of endothelial cells. In addition, the live/dead cell assay revealed many dead cells in the endothelium, and scanning electron microscopy analysis showed that corneal endothelial cells exhibited a partial loss of microvilli on the surface as well as extensive destruction of intercellular junctions. However, in the Cosopt-S group, corneal edema was mild and the damage to the corneal endothelium was minimal. Conclusions: The main cause of corneal endothelial toxicity was due to the preservative in the dorzolamide/ timolol fixed combination eyedrops, and not the active ingredient. Thus, it appears to be safer to use preservative-free eyedrops during the early postoperative period.

Introduction To demonstrate that preoperative treatment for 28 days with topical dorzolamide/timolol is non-inferior (Δ = 4 mm Hg) to oral acetazolamide and topical dexamethasone (standard therapy) in terms of intraocular pressure (IOP) reduction 3 and 6 months after trabeculectomy in glaucoma patients. Materials and methods Sixty-two eyes undergoing trabeculectomy with mitomycin C were included in this monocentric prospective randomized controlled study. IOP change between baseline and 3 months post-op was defined as the primary efficacy variable. Secondary efficacy variables included the number of 5-fluorouracil (5-FU) injections, needlings, suture lyses, preoperative IOP change, hypertension rate and change of conjunctival redness 3 and 6 months post-op. Safety was assessed based on the documentation of adverse events. Results Preoperative treatment with topical dorzolamide/timolol was non-inferior to oral acetazolamide and topical dexamethasone in terms of IOP reduction 3 months after trabeculectomy (adjusted means -8.12 mmHg versus -8.30 mmHg; Difference: 0.18; 95% CI -1.91 to 2.26, p = 0.8662). Similar results were found 6 months after trabeculectomy (-9.13 mmHg versus -9.06 mmHg; p = 0.9401). Comparable results were also shown for both groups concerning the classification of the filtering bleb, corneal staining, and numbers of treatments with 5-FU, needlings and suture lyses. More patients reported AEs in the acetazolamide/dexamethasone group than in the dorzolamide/timolol group. Discussion Preoperative, preservative-free, fixed-dose dorzolamide/timolol seems to be equally effective as preoperative acetazolamide and dexamethasone and has a favourable safety profile.

PURPOSE To investigate the intraocular pressure (IOP)-lowering efficacy and safety of dorzolamide/timolol fixed combination (DTFC) in patients with normal-tension glaucoma (NTG). METHODS An open-label, 12-week, 2-center study was conducted. Thirty-seven patients with treatment-naive NTG received DTFC for 12 weeks to reduce IOP. Primary outcome measures were changes in IOP from baseline to 12 weeks of treatment at a peak drug effect. Secondary outcome measures were changes in IOP from baseline to 12 weeks of treatment a trough drug effect and 8 hours after drug administration. At each visit, IOP was measured at 9 AM and then DTFC was administered by a hospital personnel. IOP was also measured at 11 AM and 5 PM At week 12, the IOP was measured at 1 and 3 PM as well. RESULTS The IOP at peak drug effect (11 AM) at 12 weeks was significantly reduced to 11.9±2.6 mm Hg from the baseline of 15.6±2.5 mm Hg (23.7%, P

To evaluate prospectively whether anti-glaucomatic drugs administered prior to intravitreal anti-vascular endothelial growth factor (VEGF) injection bevacizumab (Avastin,® Roche) or ranibizumab (Lucentis,® Novartis) prevents intraocular hypertension after the injection.In total, 166 patients (175 eyes) scheduled for intravitreal anti-VEGF injection treatment were prophylactically treated 1 hour before the procedure with Dorzolamide/Timolol (Cosopt,® MSD) (Group 1, 53 eyes) or Brinzolamide/Timolol (Elazop,® Alcon) (Group 2, 84 eyes) or left untreated (Group 3, 29 eyes). Intraocular pressure was analyzed 5 minutes prior to the injection, every 5 minutes for 30 minutes after the procedure, and 1 hour, 1 day, 7 days, and 1 month after the procedure.The intraocular pressures 5 minutes before the procedure (baseline) for Groups 1, 2, and 3 were 12.06 ± 1.85, 13.98 ± 2.68, and 13.81 ± 2.24 mmHg, respectively. Five and 30 minutes after the procedure, the intraocular pressures of the three groups were 14.12 ± 4.18, 14.87 ± 3.35, and 28.21 ± 3.16 mmHg, respectively, and 10.87 ± 1.58, 14.25 ± 2.43, and 17.48 ± 2.34 mmHg, respectively. For all three groups, the changes relative to baseline 5 and 30 minutes after injection were significant. When the three groups were divided according to whether they received bevacizumab or ranibizumab and the changes in intraocular pressure relative to baseline were analyzed, all six subgroups exhibited significant changes in intraocular pressure 5 and 30 minutes after the procedure.The prophylactic administration of anti-glaucomatic drugs prior to intravitreal anti-VEGF injection effectively reduced the early intraocular pressure elevation. This approach was also safe and could be performed accurately.

Introduction. Combining two medications in one bottle may improve compliance by reducing the time required to administer drops and the frequency of the total number of medication bottles. Objective. To compare the efficacy of reduced intraocular pressure (IOP) and safety of fixed combination travoprost 0.004%/timolol 0.5% vs. fixed combination dorzolamide 2%/timolol 0.5% in patients with primary open-angle glaucoma or ocular hypertension. Methods. Prospective randomized clinical study included 60 patients divided into 2 groups. Follow-up was done at day 14 and 45 and month 3. IOP measurements were taken at each follow-up examination at 8 am, 10 am and 4 pm. Results. Both fixed combinations reduced IOP significantly compared to initial values at all follow-ups (p

Purpose To compare the efficiency of brinzolamide/brimonidine fixed combination vs the dorzolamide/timolol fixed combination. Methods Forty-four eyes of 44 patients were divided in 2 groups treated either with dorzolamide/timolol twice a day (group A) or with brinzolamide/brimonidine twice a day (group B). Complete ophthalmic examination including Goldmann applanation tonometry was performed before treatment administration and 1, 4, 8, and 12 weeks afterwards. The intraocular pressure (IOP) was measured twice a day (morning at 9 AM and afternoon at 4 PM). Results At the end of the follow-up period (12 weeks), mean morning IOP reduction was 7.0 ± 2.8 mm Hg in group A and 8.4 ± 1.9 mm Hg in group B. A significant difference was found (p = 0.0343). In contrast, mean afternoon IOP reduction was 8.6 ± 2.7 mm Hg in group A and 7.9 ± 1.6 mm Hg in group B and no significant difference was found (p = 0.3413). No significant adverse effects were observed in either group. Conclusions Brinzolamide/brimonidine seems to be an effective and safe alternative β-blocker free fixed combination, especially for patients with comorbidities, having its own antihypertensive profile.

To compare the efficacy and safety of dorzolamide hydrochloride 2%/timolol maleate 0.5% fixed combination (DTFC) with latanoprost 0.005%/timolol maleate 0.5% fixed combination (LTFC) on diurnal intraocular pressure (IOP) in patients with primary open-angle glaucoma.Thirty-three primary open-angle glaucoma patients with IOP of 22-32 mmHg measured at any time were included. Patients were randomized to either DTFC twice daily or latanoprost 0.005%/timolol maleate 0.5% fixed combination (LTFC) once a day in the evening. After a 6-week treatment period with each combination, IOP were measured every 4 h during 24 h (first diurnal curve) and after 6 weeks of washout period, the patients were switched to the other treatment for 6 weeks of the second diurnal curve.The mean baseline IOP was 25.09±2.8 mmHg. After the treatment period, mean diurnal IOP was statistically lower with LTFC (16.3 mmHg) than with DTFC (17.3 mmHg), and the peak IOP value was 18.5 mmHg with LTFC and 19.9±2.6 mmHg with DTFC (P0.05). No significant side effects were reported except stinging and bitter taste with the DTFC group.Mean diurnal IOP and peak IOP were lower with LTFC than with DTFC in patients with primary open-angle glaucoma.

Objectives: We aimed to compare the effects of fixed combinations of dorzolamide/timolol maleate (DTFC) and la-tanoprost/timolol maleate (LTFC) at primary open angle glaucoma patients and assess the patient compliance to treatment. Materials and Methods: Forty-four eyes of 24 patients taking LTFC, 35 eyes of 24 patients taking DTFC and totally 79 eyes of 48 patients were included in this study. Patients were followed for 6 months. At 3rd month, diurnal in-traocular pressure (IOP) fluctuations were assessed. Perimetry and retinal nerve fiber layer (RNFL) analyze were repeated at 6th month. Results: Both medicines had efficiently controlled the IOP and diurnal fluctuations and statistically no significant dif-ference was observed (p>0.05). Perimetric and RNFL measurements were not different in both groups(p>0.05).When we have compared the results of baseline and 6th months, MD and sLV values decreased, RNFL in some cases in-creased on the other hand we have also observed a decrease in some cases(p0.05). Most of the patients did not forget to take their medicines (DTSK %54.2 and LTSK %66.7) and in following visits, compliance and adherence were improved in both groups. It is detected that duration of medi-cine use may affect the compliance (p=0.007). Conclusion: It is observed that two medicines controlled the IOP and diurnal fluctuations clinically efficient and effec-tively, had reasonable side effects and had high patient compliance to treatment., Amaç: Primer açık açılı glokomu olan hastalarda, dorzolamid-timolol maleat (DTSK) ve latanoprost-timolol maleat (LTSK) sabit kombinasyonlarının etkilerini karşılaştırmayı ve tedaviye hasta uyumunu değerlendirmeyi amaçladık. Gereç ve yöntem: LTSK kullanan 24 hastanın 44 gözü, DTSK kullanan 24 hastanın 35 gözü olmak üzere toplam 48 hastanın 79 gözü çalışma kapsamına alındı. Hastalar 6 ay takip edildi. Üçüncü ayda gün içi göz içi basıncı (GİB) dal-galanmalarına bakıldı. Görme alanı ve retina sinir lifi tabakası (RSLT) analizi 6.ayda tekrarlandı. Bulgular: Her iki ilacın da GİB\'nı ve gün içi dalgalanmalarını etkin bir şekilde kontrol ettiği ve aralarında istatistiksel olarak anlamlı bir fark bulunmadığı gözlendi(p>0.05). Görme alanı ve RSLT ölçümlerinde iki grup arasında istatistik-sel olarak anlamlı bir fark yoktu(p>0.05). Başlangıç ve altıncı ay karşılaştırıldığında, MD ve sLV değerlerinde azalma, RSLT ölçümlerinde ise azalma ve artma yönünde değişiklikler istatistiksel olarak anlamlı bulundu(p0.05). Her iki grupta da başlangıçta hastaların çoğu ilaç alımını unutmadı(DTSK %54.2 ve LTSK %66.7). Ta-kip eden kontrollerde, iki grupta da kompliyans ve adherens arttı. İlaç kullanım süresinin kompliyansı etkileyebildiği bulundu (p=0.007). Sonuç: Her iki ilacın da, GİB\'nı ve gün içi dalgalanmalarını etkin ve klinik olarak yeterli bir şekilde kontrol edebildiği, tolere edilebilir yan etkilere sahip oldukları ve hastaların tedavi uyumlarının yüksek olduğu görüldü.

Background Glaucoma is a leading cause of irreversible blindness. The fundamental problem in medical management of glaucoma is of patient compliance. An ideal drug or a drug combination is needed to slow the progression of this majorly symptomless disease. Aim To compare the efficacy and tolerability of the fixed combination latanoprost and timolol instilled once daily in the evening vs fixed combination of dorzolamide and timolol instilled twice daily in primary open angle glaucoma or ocular hypertension. Materials and methods A 12-week, randomized, open, parallel group study including 50 patients with primary open angle glaucoma or ocular hypertension was conducted at a tertiary care hospital. Patients were randomized to group 1, (fixed combination (FC) latanoprost and timolol eye drops, once daily in evening) and group 2, (FC dorzolamide and timolol eye drops, twice daily). At baseline, 2, 4 and 12 weeks, IOP was recorded at 9 AM and 12 noon. The difference in IOP reduction in two treatment groups from baseline to 12 weeks was the main outcome measure. Results Mean diurnal IOP was similar at baseline for both groups. Mean reduction in IOP from baseline to 12 weeks was 9.92 mm Hg (p = 0.001) in group 1 and 9.22 (p = 0.001) in group 2. The reduction in IOP in both groups 1 and 2 was statistically significant at all time intervals. There was a statistically significant advantage for group 1 at 12 weeks for both time readings (p = 0.013 and 0.002 respectively) as compared to group 2. Conclusion The fixed combination of latanoprost and timolol was more effective than that of dorzolamide and timolol in reducing mean diurnal IOP and both treatments were well tolerated. To confirm further such studies are required. How to cite this article Ratol S, Walia R, Chaudhry M. A Comparative Analysis of the Efficacy and Safety of fixed Combinations of Latanoprost/Timolol vs Dorzolamide/Timolol in Primary Open Angle Glaucoma or Ocular Hypertension. J Postgrad Med Edu Res 2012;46(4):172-176.

Objetivo: Evaluar las diferencias en cuanto a eficacia hipotensora y amplitud de pulso ocular entre las combinaciones fijas de dorzolamida/timolol y brinzolamida/timolol. Métodos: Estudio transversal en 25 sujetos sanos. En cada paciente uno de los ojos fue tratado con la combinación fija dorzolamida/timolol y el otro con brinzolamida/timolol. La asignación fue realizada al azar en cada paciente. Tras la instilación, mediante una escala visual analógica se evaluaron los posibles efectos adversos (visión borrosa, picor…) en cada uno de los ojos. Esta evaluación se repitió a los 30 minutos de la instilación. Mediante un tonómetro de contorno dinámico se registró la presión intraocular y la amplitud de pulso ocular a nivel basal y a las dos horas de la instilación. Resultados: Ambas combinaciones fijas disminuyeron de forma significativa la presión intraocular y la amplitud de pulso ocular sin diferencias significativas entre los dos grupos de tratamiento. De los acontecimientos adversos evaluados, el picor fue significativamente mayor en los ojos tratados con dorzolamida/timolol en la primera medida (p = 0,011). Esta diferencia desapareció en la segunda evaluación. Conclusiones: Ambas combinaciones fijas demostraron ser igualmente eficaces, produciendo variaciones similares y significativas en la amplitud de pulso ocular. Los efectos adversos fueron en ambos casos leves y bien tolerados presentándose únicamente el picor como más frecuente en los ojos tratados con dorzolamida/timolol. Objective: To determine possible differences in the intraocular pressure (IOP) and ocular pulse amplitude (OPA) lowering capacity of the fixed drug combinations dorzolamide/timolol and brinzolamide/timolol. Methods: In this cross-sectional study, one of the eyes of 25 healthy subjects was randomly assigned to treatment with dorzolamide/timolol and the other eye with brinzolamide/timolol. After instilling the drops, possible adverse effects (e.g., blurred vision, itching) were assessed in each eye. This assessment was repeated 30minutes later. IOP and OPA were determined In each eye by dynamic contour tonometry at baseline and two hours following treatment. Results: Both fixed drug combinations significantly reduced IOP and OPA with no differences detected between treatment groups. Among the adverse effects recorded, itching was significantly greater in the first assessment in the eyes treated with dorzolamide/timolol (P = .011). This difference was no longer apparent in the second assessment. Conclusions: Both fixed combinations were similarly effective in reducing intraocular pressure and ocular pulse amplitude. Adverse effects related to both treatments were mild and well-tolerated, though itching occurred most frequently in the eyes treated with dorzolamide/timolol.

To report the long-term effect of the dorzolamide/timolol (DTFC) and latanoprost/timolol (LTFC) fixed combinations on intraocular pressure (IOP) and visual field defects over time in naïve primary open-angle glaucoma (POAG) patients.Prospective, 4-year, open-label, interventional study.high-volume outpatient clinic.178 patients were assigned to receive medical treatment with either DTFC or LTFC.over 4 years, tri-monthly IOP and yearly visual field assessment (Octopus 101, Program G2). outcomes: effect of treatment on IOP, visual field indices mean defect (MD), and visual field indices variance loss (VL) over time.DTFC and LTFC significantly (por = 0.001) reduced mean IOP over time (from 22.6 +/- 3.0 to 13.8 +/- 1.9 mmHg and from 22.3 +/- 4.0 to 14.7 +/- 1.9 mmHg, respectively). In all, 56 patients (70.9%) and 14 (17.9%) showed a significant MD improvement in the DTFC- and LTFC-treated groups, respectively, p = 0.0001. DTFC progressively and significantly decreased mean VL (from 30.21 +/- 23.88 to 8.11 +/- 8.50 dB). Mean sensitivity slopes during follow-up were 1.14 dB/year and -0.34 dB/year for DTFC and LTFC treatment groups, respectively; p = 0.028.Both treatments significantly reduced IOP as compared with baseline. Additionally, treatment with dorzolamide/timolol fixed combination seem to be effective in preventing glaucomatous visual field progression. This study has some limitations that should be noted, among them its open-label design.

The aim of this study was to compare the efficacy and tolerability of preservative-free (PF) and preservative-containing (PC) formulations of the dorzolamide/timolol fixed combination (COSOPT™) in patients with elevated intraocular pressure (IOP).A parallel, randomized, double-masked study was conducted. After a 3-week run-in on timolol, patients with ocular hypertension, as confirmed by an IOP ≥22 mmHg, were randomized 1:1 to receive PF or PC dorzolamide/timolol twice daily for 12 weeks. IOP was measured at hour 0 (drug trough) and hour 2 (drug peak) at baseline (last day of 3-week timolol run-in), and weeks 2, 6 and 12.A total of 261 patients were randomized. Mean baseline IOPs were 23.7 mmHg for both treatments at hour 0 and 21.2 mmHg for PF dorzolamide/timolol and 21.4 mmHg for PC dorzolamide/timolol at hour 2. At all study time points (trough and peak at weeks 2, 6, and 12), the difference between treatments in mean change from baseline IOP was0.5 mmHg. The 95% confidence intervals for the estimated treatment difference (PF minus PC) in mean change from baseline IOP at week 12 was -0.86 to 0.23 mmHg for trough (primary endpoint) and -0.39 to 0.67 mmHg for peak (secondary endpoint). The most common adverse events were ocular burning/stinging, reported by 16.0% and 21.5% of patients receiving PF and PC dorzolamide/timolol respectively, and taste perversion, reported by 3.1% and 5.4% of patients receiving PF and PC dorzolamide/timolol respectively.In patients with elevated IOP, PF and PC dorzolamide/timolol were equivalent in efficacy for change in trough and peak IOP, and had generally similar tolerability.

Aim: This study was designed to compare the bimatoprost/timolol combination and dorzolamide/timolol combination in glaucoma for efficacy, safety, and cost-effectiveness in a local population of Trichy in the state of Tamilnadu. Materials and Methods: Eight-week, randomized, parallel group, open-label study was conducted on 48 patients of open angle glaucoma or ocular hypertension. After initial clinical assessment and baseline investigations, bimatoprost/timolol combination (Group A) was prescribed to 22 patients (2 patients lost after initial assessment) and dorzolamide/timolol combination (Group B) to 24 patients. The patients were reviewed after second and eighth weeks for cure rate and adverse drug reaction monitoring. Results: At the end of 8 weeks, the mean reduction in intraocular pressure from baseline was 13.04 mmHg (95% confidence interval (CI): 10.67–14.70) with bimatoprost/timolol combination once daily (P < 0.01) and 9.46 mmHg (95% CI: 7.47–10.5) with dorzolamide/timolol combination twice daily. Both the treatments were safe. Cost-effective range of bimatoprost/timolol combination was lower than that of dorzolamide/timolol combination. Conclusion: The fixed combination of bimatoprost/timolol was slightly more effective than that of dorzolamide/timolol combination in reducing IOP, and both treatments were generally well tolerated. Bimatoprost/timolol combination was more cost-effective (cost-effective analysis) than dorzolamide/timolol combination.

Aims To compare intraocular pressure (IOP) reductions with fixed-combination (FC) latanoprost/timolol once daily in the evening vsFC dorzolamide/timolol twice daily. Methods This evaluator-masked, multicentre, controlled clinical trial randomized subjects with primary open-angle glaucoma or ocular hypertension with IOP insufficiently responsive to Β-blocker therapy (screening IOP>21 and

The aim of this study was to evaluate the intraocular pressure (IOP) efficacy and safety of dorzolamide/timolol in fixed combination (DTFC) versus bimatoprost in open-angle glaucoma (OAG) patients poorly controlled (or =21 mmHg) on latanoprost.This was a prospective, double-masked, randomized, controlled, cross-over evaluation. After a 6-week wash-out period, the patients then returned for baseline diurnal curve testing every 2 h (8 AM to 8 PM). Patients with an IOP of 22-29 mmHg inclusive at 8 AMwere randomized to either bimatoprost dosed each evening or DTFC twice-daily. Patients returned in 8 weeks for the Period 1 diurnal curve and were switched to the opposite treatment. Patients again returned in 8 weeks for the Period 2 diurnal curve.Of the 29 patients, mean untreated baseline IOP (visit 2) was 24.6 +/- 2.6 mmHg and treatment mean IOP was statistically lower with bimatoprost 17.6 +/- 2.0 mmHg than for DTFC 18.8 +/- 2.5 mmHg (P = 0.03), as was the IOP range (P = 0.02) and IOP peak (P = 0.003). No significant differences were found between DTFC and bimatoprost at individual time points after a modified Bonferroni correction (0.02). DTFC demonstrated a greater incidence of stinging or burning (n = 12) than bimatoprost (n = 0; P =0.0001).This study suggests that OAG patients generally can obtain similar IOP control at individual time points (when a Bonferroni correction is considered) by switching to either DTFC or bimatoprost, but overall diurnal control is statistically better with bimatoprost.

To compare the 12-hour efficacy and safety of dorzolamide/timolol fixed combination (DTFC) dosed twice daily versus latanoprost dosed every evening following a timolol run-in in primary open-angle glaucoma patients.Following a 6-week timolol run-in patients were randomized to either DTFC or latanoprost for 6 weeks and then changed to the opposite treatment for 6 weeks. At the end of the run-in, and the end of each treatment period, the intraocular pressure (IOP) was measured every 2 hours between 8:00 AM and 8:00 PM.Thirty-one patients completed at least one time point in both treatment periods. Both treatments reduced the IOP for the diurnal curve, and at each time point, from the timolol run-in baseline (p0.0001). The 12-hour IOP on timolol was 22.1+/-2.8 mmHg, whereas on DTFC it was 18.1+/-2.8 and latanoprost 18.3+/-3.1 mmHg (p=0.4). Further, there was no statistical difference in IOP between treatments at any time point (por =0.1). There was no statistical difference for any individual adverse event between treatments (p0.05).This study suggests that following a timolol run-in both DTFC and latanoprost provide comparable daytime efficacy and safety.

Jason Yeh1, Daniel Kravitz2, Brian Francis11Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 2Tulane University, School of Medicine, New Orleans, LA, USAAbstract: Glaucoma is a multifactorial optic neuropathy in which the main therapeutic target is lowering of intraocular pressure (IOP) in order to retard the progression of existing structural and functional damage. The three mainstays of treatment are pharmacologic, laser, and surgical. The primary standard therapy in patients with open-angle glaucoma or ocular hypertension is topical medication. When monotherapy does not adequately lower the intraocular pressure, one or more agents are added or substituted. Combination pharmacotherapy such as Cosopt® is available to improve efficacy and simplify medication regimen. A fixed combination of two ocular hypotensive drugs (the carbonic anhydrase inhibitor dorzolamide and the beta-adrenoceptor antagonist timolol), Cosopt® is indicated for the treatment of elevated IOP in patients with open-angle glaucoma or ocular hypertension insufficiently responsive to topical beta-adrenoceptor antagonist monotherapy. Compared with concomitant therapy with the individual components, the primary advantage of fixed combination dorzolamide – timolol is convenience, which may also improve compliance. Clinical trials have demonstrated that the fixed combination dorzolamide – timolol is safe, effective and generally well tolerated in lowering IOP in patients with open angle glaucoma or ocular hypertension, including individuals uncontrolled on beta-adrenoceptor antagonist or other monotherapy.Keywords: glaucoma, ocular hypertension, Cosopt®, fixed combination dorzolamide – timolol, dorzolamide, timolol

Purpose: The efficacy of dorzolamide/timolol fixed combination (DTFC) versus latanoprost/timolol fixed combination (LTFC) in open-angle glaucoma or ocular hypertensive patients. Methods: Patients were randomized to DTFC or LTFC for 6 weeks and switched to opposite treatment for Period 2. Results: Thirty-two completed patients had a mean diurnal IOP of 19.5 ± 3.2 mmHg for DTFC and 18.9 ± 3.4 mmHg for LTFC (p = 0.12), with no significant difference found between DTFC and LTFC at any timepoint following a Bonferroni correction (p ≥ 0.01). Conclusions: Patients treated with DTFC and LTFC have a statistically similar ocular hypotensive effect.

Purpose: To determine progression factors at the end of the Early Manifest Glaucoma Trial (EMGT) based on all EMGT patients and evaluate separately patients with higher and lower baseline intraocular pressure (IOP; median split). Design: Cohort of clinical trial participants. Participants: Patients with early open-angle glaucoma randomized to argon laser trabeculoplasty plus betaxolol (n = 129) or no immediate treatment (n = 126), examined every 3 months for up to 11 years. Methods: Cox proportional hazard analyses, expressed by hazard ratios (HRs) and 95% confidence intervals (Cls). Main Outcome Measure: Time to progression, defined by perimetric and photographic disc criteria. Results: Overall progression was 67% when follow-up ended (median, 8 years). Treatment approximately halved progression risk (HR, 0.53; 95% Cl, 0.39-0.72); results were similar for patients with higher and lower baseline IOP (HRs, 0.41 and 0.55). Baseline progression factors (HRs, 1.51-2.12; P

Increased intraocular pressure (IOP) is often associated with glaucoma, a leading cause of irreversible vision loss. Commonly, multiple medications are required to achieve IOP control in glaucoma or ocular hypertension. The fixed combination of timolol and dorzolamide is among the most commonly used antiglaucoma medications. It is more effective than either of its components used as monotherapy, and has an IOP lowering ability that is slightly less than the concomitant use of the components. The fixed combination allows the simplification of a multidrug regimen by reducing the total number of drops and preservative instilled per day, avoids washout effect from rapid sequence instillation of individual drops, and may improve adherence to chronic therapy. Although fixed combination medications are increasingly popular with several combinations available worldwide, the fixed dorzolamide–timolol combination remains the only fixed combination approved in the USA.

Summary The objective of this study was to compare the effect of the latanoprost/timolol fixed combination (LTFC) and the dorzolamide/timolol fixed combination (DTFC) on the retrobulbar haemodynamic and intraocular pressure (IOP) in patents with open-angle glaucoma (OAG). This was a prospective, examiner masked, randomised and crossover study. Participants were 32 consecutive subjects, who met the inclusion/exclusion criteria, with newly diagnosed OAG. Patients were randomised to either LTFC or DTFC for the first 1-month treatment phase after a 1-month washout period, without medical treatment, patients began with the opposite treatment for the second 1-month treatment period. Colour Doppler parameters in ophthalmic artery (OA) and posterior ciliary arteries (PCA), ocular perfusion pressure, IOP and systemic haemodynamics were assessed at each baseline and at the end of each treatment period. The main outcomes include peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) in OA and PCA. DTFC significantly increased EDV in OA from 7.55 (1.16) to 9.32 (1.22), p

To evaluate the efficacy of fixed combination brimonidine-timolol (FCBT) versus fixed combination dorzolamide-timolol (FCDT) given twice daily in patients with primary open angle glaucoma (POAG) or ocular hypertension (OH).Prospective, multicentre, masked-observer, crossover comparison.Sixteen patients with POAG and 14 with OH.The participants of the study were washed out from their previous medication and randomized to fixed FCBT or FCDT for the first 4-week treatment period. Subjects then were washed for 4 weeks and started on the opposite medication for the second 4-week period. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometer at 8:00 a.m., 12:00 noon and 4:00 p.m. at each baseline and at the end of each treatment period. Unsolicited ocular adverse events were also recorded.Comparison of the IOP lowering effect of FCBT and FCDT.The baseline mean diurnal IOP for all 30 subjects (30 eyes) was 22.9 +/- 1.6 mmHg. Both fixed combinations significantly reduced IOP compared with baseline (p0.00001). The mean diurnal IOP following 4 weeks of therapy was 15.0 +/- 2.1 mmHg for FCBT and 15.4 +/- 2.1 mmHg for FCDT (p = 0.510). The mean diurnal IOP reduction was 7.8 +/- 1.9 mmHg for FCBT and 7.4 +/- 1.8 mmHg for FCDT (p = 0.430). Overall, 14 subjects complained about ocular adverse events: two only for FCBT, seven only for FCDT and five for both drugs. Although there was no significant difference between the number of subjects that reported ocular adverse events with FCBT (n = 7) and FCDT (n = 12) (p = 0.359), FCDT caused more ocular stinging upon instillation (n = 9) than FCBT (n = 1) (p = 0.027).This study suggests that FCBT and FCDT, each given twice daily, have similar efficacy in patients with POAG or OH.

To evaluate the intraocular pressure lowering effect of the dorzolamide/timolol fixed combination (DTFC) in non-responder glaucoma patients to prostaglandin analogs/prostamides (prostas).All glaucoma patients treated with DTFC, between June 2003 and December 2005, who were unresponsive to prostaglandin analogs/prostamides, were identified through a retrospective medical records review. A non-responder was defined as an intraocular pressure (IOP) lowering effect less than 15% compared with baseline measurement. Two 12-hour IOP diurnal curves, measured between 8:00 a.m. and 8:00 p.m. (8:00 a.m., 10:00 a.m., 12:00 noon, 2:00 p.m., 4:00 p.m., 6:00 p.m. and 8:00 p.m.), were obtained retrospectively from the records of 31 patients, the first while on prostaglandin analogs/prostamides (baseline IOP) and the second while receiving DTFC (DTFC IOP). The study outcomes were the change in mean diurnal IOP and the reduction in IOP fluctuation as a result of receiving DTFC in patients unresponsive to prostas. The IOP was evaluated by intragroup comparisons with a two-tailed paired Student's t-test. A chi-square test was adopted for analysis of categorical variables.31 patients were included in this retrospective study. DTFC significantly reduced IOP in the patients overall, from 25.4 (3.5) to 20.2 (1.0) mmHg, p0.0001. The majority of patients were diagnosed with pseudoexfoliative glaucoma (PEX) (58%; 18/31). DTFC reduced the mean IOP fluctuations over 12 hours (highest minus lowest IOP reading within the 12-hours pressure curve) from 8.6 (3.2) to 4.3 (1.4) mmHg, p0.0001. The most common adverse events were ocular burning (16%) and taste perversion (13%). There were no serious treatment-related adverse events.DTFC significantly reduced the IOP in patients with glaucoma who did not respond to prostaglandin analogs/prostamides. Further research is needed to confirm these results.

Purpose. To compare the ocular pulse amplitude (OPA) lowering effects of preservative-free tafluprost and dorzolamide-timolol fixed combination (DTFC) using dynamic contour tonometry.Methods. In total, 66 eyes of 66 patients with normal tension glaucoma (NTG) (n=34) or primary open angle glaucoma (POAG) (n=32) were included. Patients were divided into two groups: the preservative-free tafluprost-treated group (n=33) and the preservative-free DTFC-treated group (n=33). Intraocular pressure (IOP) was measured using Goldmann applanation tonometry (GAT). OPA was measured using dynamic contour tonometry; corrected OPA (cOPA) was calculated at baseline and at 1 week and 1, 3, and 6 months after treatment.Results. After 6 months of treatment, tafluprost significantly reduced IOP (P<0.001). The OPA lowering effects differed significantly between the two treatment groups (P=0.003). The cOPA-lowering effect of tafluprost (1.09 mmHg) was significantly greater than that of DTFC (0.36 mmHg) after 6 months of treatment (P=0.01).Conclusions. Tafluprost and DTFC glaucoma treatments provided marked OPA and IOP lowering effects. Tafluprost had a greater effect than DTFC; thus, this drug is recommended for patients at risk of glaucoma progression, due to the high OPA caused by large fluctuations in IOP.