Document Detail

The additive effect of latanoprost to maximum-tolerated medications with low-dose, high-dose, or no pilocarpine therapy.
MedLine Citation:
PMID:  9951495     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the efficacy of latanoprost additive therapy in patients with intraocular pressure (IOP) out of control while taking maximum-tolerated medications and to determine whether pilocarpine therapy has a dose-dependent adverse effect on the efficacy of latanoprost therapy. DESIGN: Noncomparative case series. PARTICIPANTS: Sixty-one eyes of 61 patients with chronic glaucoma with IOP out of control while receiving maximum-tolerated medications were treated with latanoprost additive therapy on a compassionate basis. MAIN OUTCOME MEASURES: Follow-up was up to 22 months with a mean of 13.9 +/- 5.7 months. Kaplan-Meier survival analysis with Mantel-Cox log-rank test was performed to determine the overall success of latanoprost additive therapy and to compare the success rates of high-dose pilocarpine, low-dose pilocarpine, and no pilocarpine therapies. The criterion for success was avoiding glaucoma surgery with IOP decrease of 20% or greater and final IOP less than 22 mmHg. The IOP change and its significance for patients satisfying and failing the criterion for success also were determined to assess the latanoprost additive therapy. In addition, a number of pretreatment variables, including pilocarpine therapy, were analyzed for a significant effect on the efficacy of latanoprost additive therapy using Cox proportional hazards regression analysis. RESULTS: Latanoprost additive therapy significantly lowered mean IOP by 3.9 +/- 5.5 mmHg at 3 months and by 3.5 +/- 5.8 mmHg at 12 months. The cumulative success rate of the latanoprost additive therapy was 70% at 1 month, 42% at 3 months, 40% at 6 months, and 30% at 12 months. Of the variables studied, only increased number of previous incisional glaucoma surgeries and IOP greater than 24 mmHg before latanoprost additive therapy were significant prognostic factors for failure of latanoprost additive therapy. Pilocarpine therapy in any dose had no significant effect. CONCLUSION: This study supports a trial of latanoprost additive therapy before glaucoma surgery in patients with IOP out of control while receiving maximum-tolerated medications irrespective of pilocarpine therapy and the pilocarpine dosage, especially when the number of previous incisional glaucoma surgery is less than three and the IOP is less than 25 mmHg.
D H Shin; M S McCracken; R E Bendel; R Pearlman; M S Juzych; B A Hughes; L L Schulz; C Kim; N H Baek
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Ophthalmology     Volume:  106     ISSN:  0161-6420     ISO Abbreviation:  Ophthalmology     Publication Date:  1999 Feb 
Date Detail:
Created Date:  1999-02-12     Completed Date:  1999-02-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  386-90     Citation Subset:  IM    
Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan, USA.
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MeSH Terms
Aged, 80 and over
Dose-Response Relationship, Drug
Drug Synergism
Follow-Up Studies
Glaucoma / drug therapy*
Intraocular Pressure / drug effects*
Middle Aged
Ophthalmic Solutions / administration & dosage,  therapeutic use
Pilocarpine / administration & dosage,  therapeutic use*
Proportional Hazards Models
Prospective Studies
Prostaglandins F, Synthetic / administration & dosage,  therapeutic use*
Survival Analysis
Treatment Outcome
Reg. No./Substance:
0/Ophthalmic Solutions; 0/Prostaglandins F, Synthetic; 130209-82-4/latanoprost; 92-13-7/Pilocarpine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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