Twenty-four hour intraocular pressure reduction with latanoprost compared with pilocarpine as third-line therapy in exfoliation glaucoma.
OBJECTIVE
To compare the 24 hour efficacy of latanoprost 0.005% given every evening with that of pilocarpine 4% given four times daily as third-line therapy in patients with exfoliation glaucoma receiving timolol 0.5% and dorzolamide 2% each given twice daily.


METHODS
We enrolled 30 patients with exfoliation glaucoma not adequately controlled on timolol maleate 0.5% and dorzolamide 2%. Each patient underwent a baseline 24 hour intraocular pressure curve testing at 06:00, 10:00, 14:00, 18:00, 22:00 and 02:00 hours. Patients were randomised to receive either latanoprost 0.005% or pilocarpine 4% for a minimum of 8 weeks and were then crossed over to the opposite therapy. Diurnal curve testing was repeated at the end of each treatment.


RESULTS
There was a significant decrease from baseline in intraocular pressure at each timepoint for both study medicines (p < 0.016). Latanoprost provided better intraocular pressure control than pilocarpine at daytime measuresments (17.4 vs 19.7 mmHg at 06:00 hours, p < 0.001; 17.8 vs 19.1 mmHg at 10:00 hours, p = 0.04). However, pilocarpine reduced the pressure more than latanoprost at 22:00 hours (18.4 vs 19.5 mmHg, p = 0.016). Overall, the diurnal intraocular pressure was reduced from a baseline of 21.5 +/- 3.7 mmHg to 18.8 +/- 3.1 mmHg on pilocarpine and to 18.0 +/- 3.0 mmHg on latanoprost (p = 0.06). In addition, mean peak pressure was similar between pilocarpine (21.0 +/- 2.9 mmHg) and latanoprost (20.5 +/- 3.8 mmHg) (p = 0.20). Side-effects were similar with the exception of blurred vision, which was only found with pilocarpine (10%). Compliance was more difficult with pilocarpine.


CONCLUSIONS
In exfoliation glaucoma, as a third-line adjunctive therapy added to timolol and dorzolamide, latanoprost and pilocarpine have similar diurnal efficacy. However, latanoprost provides a greater morning pressure reduction.
Konstas
A G
AG
University Department of Ophthalmology AHEPA Hospital, Thessaloniki, Greece. konstas@med.auth.gr
Lake
S
S
Maltezos
A C
AC
Holmes
K T
KT
Stewart
W C
WC
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002940:Circadian Rhythm / Q000502:physiology; D018592:Cross-Over Studies; D004334:Drug Administration Schedule; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology; D000077338:Latanoprost; D008297:Male; D008875:Middle Aged; D008916:Miotics / Q000009:adverse effects / Q000627:therapeutic use; D018721:Muscarinic Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D010862:Pilocarpine / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011461:Prostaglandins F, Synthetic / Q000009:adverse effects / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D008916:Miotics; D018721:Muscarinic Agonists; D011461:Prostaglandins F, Synthetic; D010862:Pilocarpine; D000077338:Latanoprost