Latanoprost for uncontrolled glaucoma

Purpose. To evaluate the ocular hypotensive response of tatanoprost 0.005% administered as adjunctive therapy in patients with glaucoma receiving maximal tolerated medical therapy. Methods. One hundred sixty consecutive patients entering a latanoprost compassionate clinical trial were enrolled at two sites. Latanoprost 0.005% was administered as a single drop between 6:00 and 8:00 P.M. and all other medications were continued, intraocular pressure (1OP) was measured between 2:00 and 4:00 P.M. Responders were defined as a reduction in IOP of at least 20% from baseline. Results. Mean pretreatment IOP was 23.3 ±6.9 mmHg. Patients were using a mean of 2.5 ±1.3 ocular hypotensive medications. IOP was significantly reduced compared with baseline measurements (P<0.01) with mean IOP reductions of 4.1 ±5.2, 4.0 ±6.3, and 3.7 ±4.2 mmHg at the 1, 3, and 6 month intervals, respectively. A reduction in IOP of at least 20% was observed in 64/144 (44.4%), 46/107 (43.0%), and 10/31 (32.3%) patients at the 1, 3. and 6 month visits, respectively. A 40% reduction in IOP was observed in 18/144 (12.5%) and 9/107 (8.4%) patients at 1 and 3 months, respectively. Patients with higher prc-sludy lOPs tended to have a greater response to treatment (P<0.0001). Concomitant miotic therapy did not alter the response to latanoprost therapy (P>0.4 at all intervals). Eight (5.0%) patients developed ocular allergy or irritation necessitating cessation of latanoprost therapy. Conclusion. Latanoprost 0.005% may provide significant further IOP reduction in patients receiving maximal tolerated medical therapy.