A Long-term Safety Study of Latanoprost in Pediatric Patients With Glaucoma and Ocular Hypertension: A Prospective Cohort Study

The risk of uveitis due to prostaglandin analogs in pediatric glaucoma

PURPOSE

To examine the incidence of uveitis in children prescribed prostaglandin analogs (PGAs) for glaucoma.

METHODS

In this dual-center cohort study, the medical records of consecutive patients <18 years old treated with a PGA between January 1, 2012, and December 31, 2018, were reviewed retrospectively. Patients with all forms of glaucoma, including those with a prior history of uveitis, were included. Patients who had been on a PGA prior to their first recorded visit were excluded. Patient charts were reviewed for new or recurrent uveitis during the first year of PGA therapy.

RESULTS

A total of 103 children (147 eyes) were included, with a total PGA exposure of 1,352 child-months. Ninety-eight children (142 eyes) tolerated the PGA without an episode of uveitis. Five patients with a documented prior history of uveitis experienced a unilateral episode of uveitis. A review of their medical records identified prescribed or unscheduled decrease in topical steroids or immunosuppressive medication as the most likely cause of uveitis recurrence.

CONCLUSIONS

This study provides further evidence that PGAs are unlikely to induce uveitis in children being treated for glaucoma and suggests that this may also be true in those with a history of uveitis. We are unable to evaluate whether PGAs make recurrence more likely or the tapering of steroids more difficult.

Epidemiological Characteristics of Inpatients Undergoing Surgery for Glaucoma at Tianjin Eye Hospital from 2013 to 2017

Purpose

To analyze the epidemiological characteristics of inpatients who underwent surgery for glaucoma at Tianjin Eye Hospital from 2013 to 2017.

Methods

All glaucoma inpatients who underwent surgery at Tianjin Eye Hospital from 2013 to 2017 were evaluated. The relationships of age and sex with different types of glaucoma were analyzed. The differences in the prevalence and family history of glaucoma among patients with different systemic diseases were compared. Additionally, the effects of different surgical methods for primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) were compared.

Results

A total of 4539 patients with glaucoma were retrospectively analyzed. The most prevalent type was PACG (60.15%), followed by secondary glaucoma (SG, 25.53%), POAG (7.6%), uncontrollable intraocular pressure (IOP) after antiglaucoma surgery (4.71%), mixed glaucoma (MG, 10%), and congenital glaucoma (CG, 0.9%). The main surgical methods were phacoemulsification (phaco), phacotrabeculectomy (phaco-trab), and trabeculectomy (trab). The rate of phaco-trab increased, while that of trab decreased. The proportion of women in the PACG group was higher than those in the POAG and SG groups, and there was a pronounced tendency for family clustering (P < 0.001), while in the POAG and SG groups, the proportions of men and those with diabetes were higher (P < 0.05).

Conclusions

In Tianjin Eye Hospital from 2013 to 2017, the main type of glaucoma was PACG. Female sex and a family history of glaucoma were risk factors for PACG, while male sex and hyperglycemia were risk factors for POAG and SG. Among the antiglaucoma surgery methods, the proportion of phaco-trab increased, while the proportion of trab decreased.

The Glaucoma Italian Pediatric Study (GIPSy): The Long-term Effect of Topical Latanoprost on Central Corneal Thickness

PRECIS

Central corneal thickness (CCT) may increase over time in children affected by primary congenital glaucoma and treated with latanoprost for at least 30 months.

PURPOSE

The purpose of this study was to investigate CCT modification over time in a population of primary pediatric glaucoma (PPG) patients prescribed a monotherapy of latanoprost.

MATERIALS AND METHODS

The present paper reports the results of a post hoc analysis on patients enrolled in the Glaucoma Italian Pediatric Study (GIPSy). Children affected by PPG, with a postsurgical intraocular pressure between 22 and 26 mm Hg and treated with latanoprost monotherapy for at least 30 months were eligible for the analysis. CCT variation from baseline was investigated over the follow-up using univariable and multivariable longitudinal linear mixed models. The impact of age, sex, and intraocular pressure on CCT variation were evaluated taking into account the interaction of each variable with time.

RESULTS

Twenty-seven eyes (20 patients) were included in the analysis. Mean duration of latanoprost treatment was 36.6 months (SD 2.5) and mean CCT at baseline was 551 μm (SD 37.7). A significant increase of CCT over time was revealed by multivariable analysis, taking into account the impact of age at baseline and its interaction with time (P=0.03). The interaction between age and time was significant (P=0.04), indicating that older age at baseline was associated with lower increase of CCT over time. No variation of CCT was found in univariable analysis (P=0.28).

CONCLUSION

In this population of PPG patients treated with latanoprost for at least 30 months, CCT significantly increased over time, when the impact of age and its interaction with time were considered.

Medical management of pediatric glaucoma: lessons learned from randomized clinical trials

PURPOSE

To critically discuss the randomized clinical trials (RCTs) on glaucoma medical therapy for the management of pediatric glaucoma.

METHODS

RCTs on glaucoma drugs carried out on pediatric subjects with ocular hypertension and glaucoma were identified through systematic searches. The methods of the RCTs and the safety and the efficacy of the glaucoma drugs were reviewed and discussed.

RESULTS

We included five RCTs. One study compared dorzolamide with 0.5% timolol gel; one brinzolamide with 0.5% levobetaxolol; one 0.25% betaxolol, 0.25% timolol gel, and 0.5% timolol gel; one latanoprost with 0.5% timolol; and one travoprost with 0.5% timolol. The primary outcome was safety for two studies and efficacy for three studies. None of the RCTs was powered to detect statistically significant differences in intraocular pressure (IOP) between treatments. In total, 658 subjects received at least one dose of study medication. Beta-blockers were administered to 359 patients, carbonic anhydrase inhibitor (CAI) to 154, and prostaglandins to 145 patients. IOP-lowering efficacy ranged from 20 to 23% for CAI, from 9 to 36% for beta-blockers, and from 26 to 27% for prostaglandins. The percentage of responders was 50% for CAI, ranged from 38 to 74% for beta-blockers and from 60 to 83% for prostaglandins. Two patients receiving timolol experienced a systemic, drug-related serious adverse event (one patient bradycardia and one pneumonia). Systemic, nonserious drug-related events occurred in 15 patients randomized to beta-blockers and in 8 patients randomized to CAI. No adverse events occurred in children treated with prostaglandins.

CONCLUSION

RCTs that are available on medical therapy for glaucoma are few and underpowered. The proportion of responders is lower in children; however, in subjects who are responders, the efficacy of glaucoma drugs seemed to be comparable to that in adults. As systemic adverse events have been reported, including serious events with timolol, a particular attempt to minimize the absorption of the drug (using the lowest dose and the gel formulation of beta-blockers or considering the lacrimal punctum occlusion) and a follow-up that is more frequent and more focused on safety should be considered in pediatric subjects who are on topical glaucoma medications.

[Long-term use of latanoprost in the treatment of glaucoma]

Glaucoma is the main cause of irreversible blindness in the world. Latanoprost - an ester prodrug of prostaglandin F2α (PGF2α) - was the first prostaglandin analogue used in the treatment of glaucoma. The present review shows that latanoprost is the most balanced prostaglandin analogue in terms of efficacy-safety. Its use improves the quality of life of glaucoma patients, provides reliable IOP reduction, has high patient compliance, and helps with the long-term preservation of visual functions. The review also reveals the possibility of long-term (more than five years) use of the drug, as well as effective combined treatment using latanoprost and beta-blockers, considers the pediatric use of latanoprost, and discusses its neuroprotective properties.

New glaucoma medications: latanoprostene bunod, netarsudil, and fixed combination netarsudil-latanoprost

Reduction of intraocular pressure is the only proven method to treat glaucoma. Initial treatment of glaucoma commonly involves using anti-glaucoma medications either as monotherapy or combination therapy. Studies on aqueous humour dynamics have contributed to our understanding of aqueous outflow mechanisms that have led to the discovery of new drugs. Three new drugs (latanoprostene bunod 0.24%, netarsudil 0.02%, and fixed combination netarsudil 0.02% -latanoprost 0.005%) have been introduced recently in the market with novel mechanisms of action. Latanoprostene bunod 0.024% is a nitric oxide-donating prostaglandin F2α analogue which increases the aqueous outflow both by uveoscleral and trabecular pathways. Netarsudil 0.02% is a potent Rho kinase/norepinephrine transporter inhibitor acting by increasing the trabecular outflow, decreasing the aqueous production, and possibly decreasing the episcleral venous pressure. This review highlights the role of these drugs in the management of glaucoma, with an overview of the major clinical trials on their efficacy, safety, and tolerability.