Al- Anbar Medical Journal

Abstract

Background: Primary open angle glaucoma (POAG) is the most common form of glaucoma throughout world, accounting for about two-thirds of cases. Latanoprost is a prostaglandin (PG) F2α derivative and has a strong effect on lowering the intraocular pressure (IOP) in patients with POAG and in normal eyes.
Objectives: The aim of this study is to evaluate the IOP lowering effect and safety of latanoprost in POAG naïve patients and in patients on timolol exhibited insufficient response, in Al-Ramadi Teaching Hospital.
Patients and Methods: Forty-seven Iraqi patients (47 eyes) with POAG were enrolled in a single center (Al-Ramadi Teaching Hospital) in prospective uncontrolled observational cohort study. The mean age (± S.D) was 57.09±2.04. The baseline IOP of 38 naïve patients stratified into ≥ 21 ≤30 vs. ˃30mmHg. Nine patients who had been treated with timolol but exhibited insufficient response, they were shifted to latanoprost and enrolled in this study. All participants were treated with 0.005% latanoprost once daily (evening) for 3 months. IOP levels were measured at baseline and after 1, 2 and 3 months. The efficacy outcome was mean change and mean percent change in IOP from baseline to month 1, 2 and 3.
Results: At all follow-up visits there was a significant reduction in IOP compared with the baseline value in naïve patients treated by latanoprost as 1st line (P<0.0001) and in patients shifted from timolol to latanoprost (P<0.001). The baseline IOP was 26.69±3.22 (mean±SD) mmHg, 36.43 ±3.67 mmHg and 22.00 ±4.15 mmHg in ≥ 21 ≤30 mmHg group, ˃30mmHg group and in patients shifted from timolol to latanoprost respectively. After 3 months, the IOP was reduced by 12.31±3.22 mmHg (45.63±8.26%), 21.43±4.16 mmHg (58.40±6.33%) and 8.00±3.74 mmHg (34.88±10.02%) respectively. No evidence of an upward drift in the IOP was observed during the treatment period. The most frequently reported adverse ocular effects were mild conjunctival hyperemia. No adverse systemic effects were observed. Timolol has been added to latanoprost in five naïve patients (14.2%) to achieve the desired therapeutic objective. Three naïve patients were lost to follow up. None of the patients needed shifting from medical to surgical treatment.
Conclusion: It is highly justified to use latanoprost as 1st line monotherapy in POAG naive patients and in patients whose IOP is insufficiently controlled on β-blocker monotherapy (timolol) by shifting them to latanoprost.