Prostaglandin analogues have become a popular first line therapeutical option in reduction of elevated IOP ( Intraocular Pressure) in patients with Open Angle Glaucoma and Ocular Hypertension due to their superior 24 hr potency , convenient dosing and favorable systemic safety profile. Latanoprost , Bimatoprost and Travoprost were the most common prostaglandin analogues in the world. Last few years researches braught a new preservative free prostaglandin Talfuprost . Many studies have been focusing on a comparison between preservative free Tafluprost and Preserved Latanoprost to measure comparative efficacy and tolerance. May be the most appropriate study was puplished in 2013 (Konstas AGP, et al. Br J Ophthalmol 2013;97:1510-1515). Researches chose LAtanoprost for comparison cause it has the most efficacy and tolerance among other prostaglandin analogues. Studies showed a comparable efficacy and tolerance between preserved Latanoprost and preservative free Tafluprost except Tafluprost is more thermally stable , thus it doesnt need refrigator to be kept. Latanoprost 0.001% still the best choice as first line therapy in newly diagnosed Open Angle Glaucoma and Ocular Hypertension cases. Regarding Patients who dont care of their personal hygine and always exposed to inflammatory environment, another potent combination would be the best choice for them in mentioned indications. Latanoprost in addition to a beta blocker (Timolol). An excellent and potent combination that control entire inflow and outflow of aqueos humor , maintaining IOP all over 24 h without fluctuations which represnt a risk factor can lead gradually to optic nerve head cupping , in addition to the vasoconstriction action of timolol which as a result show higher tolerance (Less hypremia). In case of not reaching targeted IOP in predicted time , hence we can add carbonic anhydrase inhibitor (e.g. Dorzolamide) in case of former therapy with (Prostaglandin analogue + Beta blocker combination ) Or a combination of (Carbonic anhydrase inhibitor + Beta blocker ) in case of former monotherapy with only prostaglandin analogues. If so, we have two agents controlling aqueous humor inflow and one agent controlling aqueous humor outflow. Adding alpha 2 agonist (Brimonodine) is favorable cause it shows a neuroprotective action helping in rim cells survival and increasing aqueous humor outflow by activating parasympathatic system which stimulate ciliary muscles relaxation increasing aqueous humor outflow. hence we get 2 agents controlling inflow + 2 agents controlling outflow = complete control on Open Angle Glaucoma case and Ocular Hypertension. Thanks for your time Ahmed Refaiey
Posted on: Tue, 24 Jun 2014 02:45:24 +0000
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