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IOP reduction strongly linked to conjunctival hyperemia grade change
Patients should use IOP-lowering medication despite conjunctival hyperemia, clinician says.
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Long-term IOP reduction closely correlated with a relatively short-term increase in conjunctival hyperemia induced by latanoprost, a study found.
Some patients may be prone to discontinuing their IOP-lowering eye drops because of the cosmetic effects that may result from conjunctival hyperemia, the study authors said.
“Prostaglandin-related drugs, including latanoprost, are the most potent drugs in the reduction in intraocular pressure,” Hiroshi Kobayashi, MD, PhD, said. “A change of conjunctival hyperemia may be used to predict the likelihood of pressure reduction. We ophthalmologists should ask patients not to discontinue the eye drop even if they are aware of conjunctival hyperemia.”
The relationship between IOP reduction and conjunctival hyperemia may stem from the dilation of microvasculature resulting from the use of prostaglandin analogues, the authors said.
“The reason for this correlation between the change in hyperemia and intraocular pressure is not known exactly,” Dr. Kobayashi said. “One reason could be that the mechanism of both the intraocular pressure-lowering effect and the localized vessel dilation may be mediated by the FP receptor, although this reasoning is speculative. Localized vessel dilation associated with prostaglandins is thought to be related to the release of the ubiquitous vasodilator, nitric oxide.”
The study was published in the Journal of Glaucoma.
Criteria, methods
The prospective study included 114 patients with open-angle glaucoma or ocular hypertension slated to undergo treatment with Xalatan (latanoprost, Pfizer) for the fist time. Mean patient age was 60.9 years.
Patients with angle-closure glaucoma or other significant ocular disease, systemic disorders, allergic hypersensitivity or poor tolerance to latanoprost were excluded from the study.
Primary outcome measures were change in conjunctival hyperemia grade at 2 days and change in IOP at 6 months after the start of latanoprost therapy.
Patients were slated for 3 months of follow-up. However, treatment was discontinued when a patient required no further medical or surgical treatment or failed to attend a scheduled office visit.
The complete follow-up rate was 89.4% (102 patients); the other 12 patients received one or more additional anti-glaucoma medications.
IOP reduction, hyperemia grade
Mean IOP was 22.5 mm Hg before administration of latanoprost and 16.5 mm Hg 6 months after administration.
Mean conjunctival hyperemia grade was 0.32 before latanoprost administration and 1.74 at 2 days after administration.
At 6 months, mean reductions in IOP were 1.7 mm Hg in eyes with no change in hyperemia grade, 5.2 mm Hg in eyes with a change of one grade, 7.3 mm Hg in eyes with a change of two grades and 10.8 mm Hg in eyes with a change of three or four grades.
Hyperemia severity appeared to diminish by day 5 and remain stable from 2 weeks to 6 months, the authors said. Data showed that 21 patients had no change in conjunctival hyperemia, 26 patients had a change of one grade, 47 patients had a change of two grades and eight patients had a change of three grades. – by Matt Hasson
Reference:
- Kobayashi H, Kobayashi K. A correlation between latanoprost-induced conjunctival hyperemia and intraocular pressure-lowering effect. J Glaucoma. 2011;20(1):3-6.
- Hiroshi Kobayashi, MD, PhD, can be reached at Department of Ophthalmology, Kanmon Medical Center, 1-1 Chofu-sotoura-cho, Shimonoseki 842-8510, Japan; email: kobi@earth.ocn.ne.jp.
- Disclosure: Dr. Kobayashi has no relevant financial disclosures.
