Efficacy of latanoprost additive therapy on uncontrolled glaucoma

Purpose: To assess the efficacy of latanoprost as additive therapy in patients with open-angle glaucoma and an intraocular pressure (IOP) deemed to be too high on maximum tolerated medical therapy. Study Design: Prospective case series. Methods: Consecutive patients with open-angle glaucoma, presenting to the Gulhane Military Medical Hospital Ophthalmology Clinic from May 1999 to September 2000 were enrolled. The effect of latanoprost on IOP was followed during a period of 12 months. The criterion for success was defined as having an IOP reduction of at least 20% from baseline or a final IOP of less than 22 mm Hg. Several clinical pretreatment variables (age, gender, ocular laterality, type of glaucoma, number of antiglaucomatous medications at study entry, pretreatment IOP) were analyzed for a significant effect on the efficacy of latanoprost additive therapy. Main Outcome Measure: IOP. Results: Sixty-five eyes of 35 patients were included. The mean baseline IOP ± SD was 23.3 ± 2.0 mm Hg. Two patients (5.71%) developed ocular allergy in the first month requiring cessation of latanoprost. In the remaining 61 eyes of 33 patients, IOP was significantly reduced compared with baseline measurements with a mean IOP reduction of 6.1 ± 1.8 (26.1%), 6.0 ± 2.2 (25.3%) and 5.5 ± 2.4 (23.2%) mm Hg at the 1-, 3- and 6-month follow-up controls, respectively (p < 0.001). Successful outcome was obtained in 50 (76.9%), 46 (70.7%) and 38 (58.4%) of 65 eyes at the 1-, 3- and 6-month visits, respectively. During the period from 6 to 12 months, 28 eyes underwent either a combined procedure (cataract extraction + intraocular lens implantation + trabeculectomy; 8 eyes) or only trabeculectomy (20 eyes) because of uncontrolled IOP; 4 eyes underwent the combined procedure because of visually significant cataract, and 8 eyes were lost to follow-up. Sixteen out of 21 eyes followed for more than 12 months with the same medications continued to have a successful outcome, and the mean IOP of 18.8 ± 3.7 mm Hg was significantly different from baseline (p < 0.001). None of the pretreatment variables was a significant prognostic factor for failure of latanoprost additive therapy. Conclusion: This study supports the use of latanoprost additive therapy in patients with elevated IOP already receiving maximum-tolerated medical therapy.