title: Switching from a preserved to a preservative-free prostaglandin preparation in topical glaucoma medication.
abstract: OBJECTIVE
  The purpose of this study was to investigate the tolerability and intraocular pressure (IOP) reducing effect of the first preservative-free prostaglandin tafluprost (Taflotan) in patients exhibiting ocular surface side-effects during latanoprost (Xalatan) treatment.
  
  
  METHODS
  A total of 158 patients were enrolled in this open-label multicentre study. Eligible patients had to have at least two ocular symptoms, or one sign and one symptom, during treatment with latanoprost. At baseline, the patients were directly switched from latanoprost to preservative-free tafluprost for 12 weeks. The patients were queried for ocular symptoms, and ocular signs were assessed by using tear break-up time, Schirmer's test, fluorescein staining and evaluation of conjunctival hyperaemia and blepharitis. In addition, HLA-DR and MUC5AC in conjunctival impression cytology specimens were analyzed, and a drop discomfort/quality of life (QoL) questionnaire was employed. IOP was measured at all visits.
  
  
  RESULTS
  Preservative-free tafluprost maintained IOP at the same level after 12- weeks treatment (16.4 +/- 2.7 mmHg) as latanoprost at baseline (16.8 +/- 2.5 mmHg). During treatment with preservative-free tafluprost, the number of patients having irritation/burning/stinging (56.3%), itching (46.8%), foreign body sensation (49.4%), tearing (55.1%) and dry eye sensation (64.6%) decreased to 28.4%, 26.5%, 27.1%, 27.1% and 39.4% correspondingly. The number of the patients with abnormal fluorescein staining of cornea (81.6%) and conjunctiva (84.2%), blepharitis (60.1%), conjunctival hyperaemia (84.2%) and abnormal Schirmer's test (71.5%) was also reduced significantly to 40.6%, 43.2%, 40.6%, 60.0% and 59.4% correspondingly. The tear break-up time improved significantly from 4.5 +/- 2.5 seconds to 7.8 +/- 4.9 seconds. A reduction in the number of patients with abnormal conjunctival cells based on HLA-DR and MUC5AC was also detected.
  
  
  CONCLUSIONS
  Preservative-free tafluprost maintained IOP at the same level as latanoprost, but was better tolerated in patients having signs or symptoms while on preserved latanoprost. Preservative-free tafluprost treatment resulted in improved QoL, increased patient satisfaction and drop comfort.
authors.affiliation: University of Tampere and Tampere University Hospital, Finland. hannu.uusitalo@uta.fi <hannu.uusitalo@uta.fi>
authors.forename: Hannu
authors.initials: H
authors.lastname: Uusitalo
authors.forename: Enping
authors.initials: E
authors.lastname: Chen
authors.forename: Norbert
authors.initials: N
authors.lastname: Pfeiffer
authors.forename: Françoise
authors.initials: F
authors.lastname: Brignole-Baudouin
authors.forename: Kai
authors.initials: K
authors.lastname: Kaarniranta
authors.forename: Markku
authors.initials: M
authors.lastname: Leino
authors.forename: Päivi
authors.initials: P
authors.lastname: Puska
authors.forename: Elina
authors.initials: E
authors.lastname: Palmgren
authors.forename: Thomas
authors.initials: T
authors.lastname: Hamacher
authors.forename: Günter
authors.initials: G
authors.lastname: Hofmann
authors.forename: Gernot
authors.initials: G
authors.lastname: Petzold
authors.forename: Ulrich
authors.initials: U
authors.lastname: Richter
authors.forename: Tobias
authors.initials: T
authors.lastname: Riedel
authors.forename: Martin
authors.initials: M
authors.lastname: Winter
authors.forename: Auli
authors.initials: A
authors.lastname: Ropo
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001548:Benzalkonium Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D001762:Blepharitis / Q000139:chemically induced / Q000378:metabolism / Q000517:prevention & control; D003229:Conjunctival Diseases / Q000139:chemically induced / Q000378:metabolism / Q000517:prevention & control; D017889:Exfoliation Syndrome / Q000188:drug therapy*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy*; D006068:Gonioscopy; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced / Q000378:metabolism / Q000517:prevention & control; D007429:Intraocular Pressure / Q000187:drug effects*; D000077338:Latanoprost; D008297:Male; D008875:Middle Aged; D055271:Mucin 5AC / Q000378:metabolism; D009798:Ocular Hypertension / Q000188:drug therapy; D009887:Ophthalmoscopy; D017060:Patient Satisfaction; D011310:Preservatives, Pharmaceutical / Q000008:administration & dosage* / Q000009:adverse effects; D011460:Prostaglandins F / Q000008:administration & dosage*; D011461:Prostaglandins F, Synthetic / Q000008:administration & dosage / Q000009:adverse effects; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014065:Tonometry, Ocular
chemical_list: D000959:Antihypertensive Agents; D001548:Benzalkonium Compounds; D006684:HLA-DR Antigens; C524678:MUC5AC protein, human; D055271:Mucin 5AC; D011310:Preservatives, Pharmaceutical; D011460:Prostaglandins F; D011461:Prostaglandins F, Synthetic; C485333:tafluprost; D000077338:Latanoprost