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Glaucoma Response Seen with Bimatoprost in Latanoprost Non-Responders

Most patients with primary open angle glaucoma who did not respond to latanoprost, 0.005% 2D were successfully treated with bimatoprost 0.03% 2D in a small trial by Italian ophthalmologists.

Of 15 patients who responded to bimatoprost, 12 had a higher incidence of trace-to-mild conjunctival hyperemia than those using latanoprost, report Dr. S. A. Gandolfi and Dr. L. Cimino, University of Parma, Parma.

Their prospective, randomised, cross-over clinical trial tested the efficacy of bimatoprost for lowering intraocular pressure (IOP) among patients with primary open-angle glaucoma or ocular hypertension who did not respond to latanoprost.

Patients had two 30-day treatment periods separated by a 30-day washout period. Either treatment was in a single eye only.

Eligibility criteria were as follows: IOP of more 22 mmHg in both eyes on current treatment following three separate readings more than 24 hours apart; angle wide open in both eyes; no pseudoexfoliation and/or pigment dispersion in either eye; documented medical history consistent with a less than 10% IOP decrease in both eyes following 2 month treatment with daily latanoprost 0.005%.

Clinicians measured a number of variables. These included IOP (Goldmann applanation tonometry, readings at 8 AM, 12 noon, 4 PM, 8 PM, and 12 midnight); visual acuity measured by Early Treatment of Diabetic Retinopathy Study chart, logarithm of the minimum angle of resolution; estimate of conjunctival hyperemia based on five standard photographs, which were graded as "none," "trace," "mild," "moderate," or "severe".

At the end of the study the clinicians found mean and standard deviation IOP data were 24.7 mm Hg at baseline, 24.8 mm Hg after washout, 24.1 mm Hg after latanoprost treatment, 18.1 mm Hg after bimatoprost treatment (P<0.0001). IOP on bimatoprost proved lower than both baseline and latanoprost (P=0.0001).

Thirteen of the 15 patients showed at least a 20% IOP decrease with bimatoprost treatment. None of the 15 patients showed a similar 20% decrease of IOP after 30 days of latanoprost treatment. No significant IOP changes were observed in the untreated eye in any patient.

Trace-to- mild conjunctival hyperemia was recorded more often during the bimatoprost treatment (P=0.035).
Ophthalmology 2003 Mar;110:3:609-14.

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