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Glaucoma Incidence and Treatment (continued) Latanoprost, Brimonidine, and Combination Timolol and Dorzolamide Affects Circadian Intraocular Pressure Dr Orzalesi described a randomised cross-over trial to compare 24-hour intraocular pressure (IOP) reduction induced by latan-oprost, brimonidine, and a fixed combination of timolol and dorzolamide in patients with primary open angle glaucoma (POAG) and ocular hypertension. Ten patients with POAG and 10 with ocular hypertension were treated with latanoprost, brimonidine, or a fixed combination of timolol and dorzo-lamide for 1 month. All patients underwent 4 diurnal tonometric examinations twice at baseline and twice after 1 month of treatment. The IOP was measured 3 hourly with a handheld electronic tonometer, with the patient in the supine and sitting positions, and with a Goldmann applanation tonometer by 2 evaluators. A difference in mean IOP of 2.5 mm Hg was estimated to be clinically relevant. All the drugs significantly reduced IOP compared with baseline at all times except for brimonidine at midnight, 3, and 6 am. Latanoprost was more effective for lowering IOP compared with brimonidine at 3 am and 6 am and at 3 pm, while the combination of timolol with dorzolamide was more effective than brimonidine in lowering IOP at 3 am and 9 am (p < 0.04) and at 3 pm and 6 pm (p < 0.05). In Conclusion Latanoprost and the combination of timolol and dorzolamide provided uniform circadian IOP reduction, whereas brimonidine was less effective in lowering IOP, particularly during the night.
Safety and Efficacy of Latanoprost Versus Combination Dorzolamide And Timolol Dr Spiegel presented a study comparing the intraocular pressure (IOP) lowering effect of latanoprost monotherapy with the fixed combination of dorzolamide plus timolol in patients with IOP uncontrolled by timolol alone. This prospective, multinational, open-label study included patients with unilateral or bilateral open angle glaucoma or pseudo-exfoliative glaucoma currently receiving mono or dual therapy with a ß-blocker. 226 patients with IOP 21 mm Hg after 3 to 6 weeks of run-in treatment with timolol twice daily were randomised to receive latanoprost once daily in the evening or dorzolamide and timolol twice daily. Diurnal IOP was measured at 10 am and 5 pm, at baseline and after 3 months of treatment. 205 patients (latanoprost, n = 103; dorzolamide and timolol, n = 102) were included in the per-protocol analysis. At baseline, the mean diurnal IOP was similar among patients given latanoprost and dorzolamide plus timolol. After 3 months, least square mean analysis showed both treatments resulted in a statistically significant reduction in diurnal IOP (p < 0.001; Table 2). The IOP lowering effects of the treatments were not statistically different based on the 95% confidence interval (-1.1, 0.4 mm Hg) for the difference in mean diurnal IOP reduction between the groups. However, the percentage of patients achieving diurnal IOP reduction 20% was higher in the latanoprost-treated group compared with the dorzolamide and timolol-treated group (Table 2). Table 2. Mean reduction in diurnal intraocular pressure (IOP) following 3 months' treatment with latanoprost or dorzolamide plus timolol.
Mean IOP reductions at 10 am and 5 pm were statistically significant in both groups (p < 0.001; Figure 1). At 10 am, the 2 treatments had a comparable IOP lowering effect, while at 5 pm, latanoprost showed a significantly higher IOP reducing effect (p = 0.0454). Both medications were well-tolerated. Figure 1 . Mean intraocular pressure reductions following treatment with latanoprost or dorzolamide plus timolol. * p = 0.045.
In Conclusion Monotherapy with latanoprost once daily is at least as effective as twice daily treatment with dorzolamide and timolol for patients with IOP uncontrolled by timolol alone.
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