Effects of 0.005% latanoprost solution on intraocular pressure in healthy dogs and cats

Feline Glaucoma

Feline glaucoma is best categorized as either secondary, congenital and anterior segment dysgenesis associated, or primary. More than 90% of all feline glaucoma develops secondary to uveitis or intraocular neoplasia. The uveitis is usually idiopathic and assumed to be immune-mediated, whereas lymphosarcoma and diffuse iridal melanoma account for many of the intraocular neoplastic-induced glaucoma in cats. Several topical and systemic therapies are useful in the control of the inflammation and elevated intraocular pressures associated with feline glaucoma. Enucleation remains the recommended therapy for blind glaucomatous feline eyes. Enucleated globes from cats with chronic glaucoma should be submitted to an appropriate laboratory for histologic confirmation of the type of glaucoma.

Topical Ocular Therapeutics in Small Animals

This article reviews the administration of common topical ophthalmic medications, in relation to factors influencing absorption including composition of topical ophthalmic preparations, and potential systemic effects. Commonly prescribed, commercially available topical ophthalmic medications are discussed with respect to pharmacology, their indications for use, and adverse effects. Knowledge of topical ocular pharmacokinetics is essential for the management of veterinary ophthalmic disease.

Comparative effects of latanoprost and latanoprostene bunod on intraocular pressure and pupil size in ophthalmologically normal Beagle dogs

OBJECTIVE

To compare effects of latanoprost, a topical prostaglandin analogue (PGA) commonly used to treat glaucoma and lens instability in dogs, and latanoprostene bunod, a novel PGA with a nitric oxide-donating moiety, on intraocular pressure (IOP) and pupil diameter (PD).

ANIMALS STUDIED

Ten ophthalmologically normal Beagle dogs.

PROCEDURES

Dogs were treated twice a day for 5 days in a randomly selected eye with either latanoprost or latanoprostene bunod. After a 6-week washout period, dogs were treated with the opposite drug. IOP and PD were measured at treatment times, at midday on days 1 and 5, and for 6 days post-treatment.

RESULTS

Both drugs significantly decreased IOP and PD. At midday on day 5 of treatment, mean IOP in eyes treated with latanoprost was 4.5 mmHg lower than the fellow eye and 3.0 mmHg lower than the same eye at baseline, while mean IOP in eyes treated with latanoprostene bunod was 5.5 mmHg lower than the fellow eye and 3.6 mmHg lower than baseline. Mean PD was 0.94 mm in eyes treated with latanoprost and 0.76 mmHg in eyes treated with latanoprostene bunod. There was no significant difference between the two drugs for either parameter at that time point (p = .372 and .619, respectively, for IOP relative to control and to baseline; p = .076 for PD) or when analyzed longitudinally. Significant diurnal variation in PD was noted and may have implications for treatment of lens' instability.

CONCLUSIONS

Latanoprost and latanoprostene bunod produce similar IOP reduction and miosis in normal canine eyes.

Retrospective Study of Long-Term Outcome of Phacoemulsification in 22 Feline Eyes with Presumed Congenital/Juvenile Cataracts (2007-2020)

The objective of this study was to determine the complication risk and prevalence after phacoemulsification in cats with presumed congenital/inherited cataracts. Twelve client-owned cats were included in the study. This retrospective study spanned 13 yr and involved 22 eyes. The median age at the time of surgery was 15 mo (range: 4.5-168 mo of age). Recorded complications were 3 eyes developed postoperative ocular hypertension, 1 eye developed glaucoma, 7 eyes developed feline herpes virus-1 signs, and 7 eyes developed postoperative uveitis >2 wk after surgery. No eyes had developed intraocular sarcomas at the time of their last exam. All eyes remained visual at last follow-up (range: 0.5-121 mo). Success was defined as a comfortable and visual eye without intraocular neoplasia, glaucoma, a partial or complete retinal detachment, or uveitis that occurred >2 wk after surgery or persisted longer than 2 wk. Twenty-one out of 22 eyes had a successful outcome. In this study, cats with presumed congenital/juvenile cataracts who underwent phacoemulsification had an excellent outcome.

Safety and efficacy of topically administered netarsudil-latanoprost fixed dose combination (FDC; Rocklatan™) in normal and glaucomatous dogs with ADAMTS10-open-angle glaucoma (ADAMTS10-OAG)

OBJECTIVE

The aim of the study was to evaluate safety and efficacy of topically administered 0.02% netarsudil-0.005% latanoprost fixed-dose combination (FDC) (Rocklatan™; Aerie Pharmaceutical) in normal and glaucomatous dogs with ADAMTS10-open-angle glaucoma (ADAMTS10-OAG).

ANIMALS STUDIED

Five normal and five glaucomatous beagle dogs with ADAMTS10-OAG were the study animals.

PROCEDURES

In each dog, left (OS) or right eye (OD) was randomly selected for netarsudil-latanoprost FDC treatment. Contralateral eyes served as latanoprost-treated controls. The study was divided into four consecutive study periods: following a 4-day baseline period, two sequential 8-day study periods followed with once daily (q24h) and twice daily (q12h) treatments and ending with a washout period. Efficacy was measured by diurnal intraocular pressure (IOP) and pupil diameter. Safety was assessed by routine ophthalmic examination, gonioscopy, and pachymetry. Differences in least square means of quantitative outcome measures were compared between FDC and latanoprost treatments by using the linear Gaussian model.

RESULTS

Baseline IOPs were 13.6 ± 0.7 mmHg (mean ± SEM) in normal and 28.3 ± 1.4 mmHg in OAG-affected dogs. There was a significant decrease in mean diurnal IOP following FDC administration in both normal (q24h: -2.1 mmHg; q12h: -4.1 mmHg) and glaucomatous dogs (q24h: -14.2 mmHg; q12h: -17.7 mmHg; p < .0001). There was no significant difference in the treatment effect when comparing FDC to latanoprost. Both FDC and latanoprost administration resulted in similarly significant pupil constriction (p < .0001). The FDC administration was well-tolerated but resulted in conjunctival hyperemia.

CONCLUSIONS

Once or twice daily administration of netarsudil-latanoprost FDC (Rocklatan™) and latanoprost was equally effective in lowering IOP in normal and OAG-affected dogs. There was no netarsudil-related added treatment effect.

Pilot study supporting the existence of novel lymphatic channels within the canine anterior uveal tract using Lyve-1 and CD31

OBJECTIVE

To demonstrate the existence of lymphatics in the canine anterior uvea using lymphatic-specific markers Lyve-1, Prox-1, and podoplanin, the endothelial cell marker CD31, and basement membrane matrix marker collagen IV.

DESIGN

Prospective Study.

ANIMALS

Eight normal globes from animals euthanized for unrelated health problems.

PROCEDURES

Sagittally cut serial sections of six normal canine eyes were immunofluorescence double-stained with Lyve-1 and CD31 and single-stained with colorimetric Prox-1 and collagen IV. Three serial sections from 2 additional eyes were cut in the coronal plane at the level of the ciliary body and immunofluorescence double-stained with Lyve-1 and CD31 to map lymphatic channel distribution. Lymphatics from normal canine lymph nodes were used for validation of podoplanin.

RESULTS

Four of 6 of the sagitally sectioned eyes had Lyve-1-positive lymphatic-like structures that were distinct from CD31-positive blood vessels in the iris base and ciliary body. Both of the coronally sectioned globes had Lyve-1-positive lymphatic-like structures in the ciliary body. The location of these structures was evaluated and found to be diffusely present circumferentially around the ciliary body.

CONCLUSION AND CLINICAL RELEVANCE

These results support the existence of lymphatic channels in the anterior uveal tract of the canine eye. This could indicate the presence of a novel uveolymphatic outflow pathway, which may play a role in aqueous humor outflow. Future studies are needed to confirm the existence and elucidate the role of this proposed uveolymphatic outflow pathway and potentially develop novel treatment options for managing glaucoma.

Looking into the future: Gene and cell therapies for glaucoma

Glaucoma is a complex group of optic neuropathies that affects both humans and animals. Intraocular pressure (IOP) elevation is a major risk factor that results in the loss of retinal ganglion cells (RGCs) and their axons. Currently, lowering IOP by medical and surgical methods is the only approved treatment for primary glaucoma, but there is no cure, and vision loss often progresses despite therapy. Recent technologic advances provide us with a better understanding of disease mechanisms and risk factors; this will permit earlier diagnosis of glaucoma and initiation of therapy sooner and more effectively. Gene and cell therapies are well suited to target these mechanisms specifically with the potential to achieve a lasting therapeutic effect. Much progress has been made in laboratory settings to develop these novel therapies for the eye. Gene and cell therapies have already been translated into clinical application for some inherited retinal dystrophies and age-related macular degeneration (AMD). Except for the intravitreal application of ciliary neurotrophic factor (CNTF) by encapsulated cell technology for RGC neuroprotection, there has been no other clinical translation of gene and cell therapies for glaucoma so far. Possible application of gene and cell therapies consists of long-term IOP control via increased aqueous humor drainage, including inhibition of fibrosis following filtration surgery, RGC neuroprotection and neuroregeneration, modification of ocular biomechanics for improved IOP tolerance, and inhibition of inflammation and neovascularization to prevent the development of some forms of secondary glaucoma.

Ocular Emergencies in Small Animal Patients

Small animal ocular emergencies vary from relatively benign to potentially vision or life threatening, with significant overlap in clinical signs. Careful ophthalmic examination in dim light conditions with a bright light source and competent patient head restraint are crucial to properly diagnosing ocular disease. Adjunctive ophthalmic diagnostic testing should be performed to rule out corneal ulceration, glaucoma, and dry eye before empiric topical antibiotic or steroid medications are prescribed. Most emergency cases present because of ocular redness, cloudiness, discomfort, apparent bulging, or vision loss; categorizing differential diagnoses on this basis can be helpful to the emergency clinician.

Effects of 0.02% netarsudil ophthalmic solution on intraocular pressure of normotensive dogs

OBJECTIVES

To evaluate the effect of QD or BID 0.02% netarsudil ophthalmic solution (Aerie Pharmaceuticals) on intraocular pressure (IOP) in normotensive dogs and to describe any adverse effects.

ANIMALS STUDIED

Normotensive Labrador retriever dogs were included in this study: 10 received netarsudil in one eye and artificial tears in the contralateral eye QD, and 10 received netarsudil in one eye and artificial tears in the contralateral eye BID.

PROCEDURES

Intraocular pressure curves were acquired over a 3-day acclimation period, 5-day dosing period (QD or BID-10 dogs/group), and 3-day recovery period. Toxicity was assessed daily using slit-lamp biomicroscopy and the semiquantitative preclinical ocular toxicology scoring system.

RESULTS

Once-daily dosing did not lower IOP over the entire 5-day dosing period (95% CI 0.1 to -0.9 mm Hg, P = .20) or on the last day of dosing (95% CI 0.4 to -0.9 mm Hg, P = .65). Twice-daily dosing resulted in a statistically significant, but clinically unimportant, IOP reduction over the entire 5-day dosing period (-0.6 mm Hg; 95% CI 0.05 to -1.1 mm Hg, P = .02) and on the last day of dosing (-0.9 mm Hg; 95% CI 0.2 to -1.5 mm Hg, P = .003). Adverse events were limited to transient mild-to-moderate conjunctival hyperemia during the dosing phase in eyes receiving netarsudil vs control (P < .0001).

CONCLUSIONS

Netarsudil 0.02% ophthalmic solution twice daily resulted in a small, statistically significant, but clinically unimportant, IOP reduction in normotensive dogs. Future studies should investigate efficacy in glaucomatous dogs.

Safety and efficacy of topically administered netarsudil (Rhopressa™) in normal and glaucomatous dogs with ADAMTS10-open-angle glaucoma (ADAMTS10-OAG)

OBJECTIVE

To evaluate safety and efficacy of topically administered 0.02% netarsudil ophthalmic solution (Rhopressa™; Aerie Pharmaceutical) in normal and glaucomatous dogs with ADAMTS10-open-angle glaucoma (ADAMTS10-OAG).

ANIMALS STUDIED

Five normal and 5 glaucomatous Beagle dogs with ADAMTS10-OAG.

PROCEDURES

In each dog, left or right eye was randomly selected for netarsudil treatment. Contralateral eyes were sham-treated with balanced salt solution (BSS). Following a 1-week baseline period, dogs were treated once daily (q24h) during week 2, and twice daily (q12h) during week 3; week 4 served as washout period. Efficacy was measured by diurnal intraocular pressure (IOP) and pupil diameter. Safety was assessed by routine ophthalmic examination, gonioscopy, and pachymetry. Differences in least square means of quantitative outcome measures were compared between netarsudil and BSS sham-treated eyes by linear Gaussian model.

RESULTS

Baseline IOPs were 18.5 ± 0.5 mm Hg (mean ± SEM) in normal and 27.8 ± 1.0 mm Hg in OAG dogs. Even though mean IOPs were lower in netarsudil- vs sham-treated eyes, the overall differences were neither significant nor clinically relevant, regardless of treatment frequency (q24h-normal: sham 16.4 ± 1.1 mm Hg vs treatment 15.6 ± 1.0 mm Hg; q24hr-OAG: sham 25.8 ± 2.3 mm Hg vs. treatment 25.7 ± 2.4 mm Hg; q12hr-normal: sham 15.4 ± 0.8 mm Hg vs. treatment 14.4 ± 0.8 mm Hg; q12hr-OAG: sham 26.3 ± 1.7 mm Hg vs. treatment 25.4 ± 1.8 mm Hg). Netarsudil administration was well tolerated but resulted in significant, moderate-to-severe conjunctival hyperemia (P < .001).

CONCLUSIONS

Once or twice daily administration of netarsudil resulted in marginal and clinically irrelevant IOP decreases in normal and OAG-affected dogs. Except for conjunctival hyperemia, the drug was well tolerated.

Effect of topical ophthalmic administration of 0.005% latanoprost solution on aqueous humor flow rate and intraocular pressure in ophthalmologically normal adult Beagles

OBJECTIVE

To determine the effect of topical ophthalmic administration of 0.005% latanoprost solution on aqueous humor flow rate (AHFR) and intraocular pressure (IOP) in ophthalmologically normal dogs.

ANIMALS

12 adult Beagles.

PROCEDURES

In a masked crossover design involving two 10-day experimental periods separated by a 7-day washout period, dogs were randomly assigned to first receive latanoprost or artificial tears (control) solution and then the opposite treatment in the later experimental period. Each experimental period was divided into a baseline phase (days 1 to 3), baseline fluorophotometry assessment (day 4), treatment phase (1 drop of latanoprost or artificial tears solution administered twice daily in each eye on days 5 to 9 and once on day 10), and posttreatment fluorophotometry assessment (day 10). Measured fluorescein concentrations were used to calculate baseline and posttreatment AHFRs. The IOP was measured 5 times/d in each eye during baseline and treatment (days 5 to 9) phases.

RESULTS

Mean baseline and posttreatment AHFR values did not differ significantly in either experimental period (latanoprost or control). In the latanoprost period, mean IOP was significantly lower during treatment than at baseline; there was no difference in corresponding IOP values during the control period. In the latanoprost period, mean IOP was significantly higher on the first day of treatment than on subsequent treatment days.

CONCLUSIONS AND CLINICAL RELEVANCE

In ophthalmologically normal dogs, topical ophthalmic administration of 0.005% latanoprost solution significantly decreased IOP but did not affect AHFR. Thus, the ocular hypotensive effect of latanoprost did not appear to have been caused by a reduction in aqueous humor production. (Am J Vet Res 2019;80:498-504).

Effects of sustained daily latanoprost application on anterior chamber anatomy and physiology in mice

Latanoprost is a common glaucoma medication. Here, we study longitudinal effects of sustained latanoprost treatment on intraocular pressure (IOP) in C57BL/6J mice, as well as two potential side-effects, changes in iris pigmentation and central corneal thickness (CCT). Male C57BL/6J mice were treated daily for 16 weeks with latanoprost. Control mice were treated on the same schedule with the preservative used with latanoprost, benzalkonium chloride (BAK), or handled, without ocular treatments. IOP and CCT were studied at pre-treatment, 2 "early" time points, and 2 "late" time points; slit-lamp analysis performed at a late time point; and expression of corneal and iridial candidate genes analyzed at the end of the experiment. Latanoprost lowered IOP short, but not long-term. Sustained application of BAK consistently resulted in significant corneal thinning, whereas sustained treatment with latanoprost resulted in smaller and less consistent changes. Neither treatment affected iris pigmentation, corneal matrix metalloprotease expression or iridial pigment-related genes expression. In summary, latanoprost initially lowered IOP in C57BL/6J mice, but became less effective with sustained treatment, likely due to physiological adaptation. These results identify a new resource for studying changes in responsiveness associated with long-term treatment with latanoprost and highlight detrimental effects of commonly used preservative BAK.

Effects of 0.2% brimonidine and 0.2% brimonidine-0.5% timolol on intraocular pressure and pupil size in normal equine eyes

BACKGROUND

Brimonidine is an α₂ -adrenergic agonist that decreases aqueous humour production and may increase uveoscleral outflow. It has not been evaluated in normal or glaucomatous equine eyes.

OBJECTIVES

To evaluate the efficacy and safety of brimonidine in lowering intraocular pressure (IOP), alone and in conjunction with timolol, as a treatment for equine glaucoma by comparing IOP in normal equine eyes treated with brimonidine and brimonidine-timolol, respectively, with IOP in control eyes.

STUDY DESIGN

A balanced crossover design with 16 horses receiving one of two treatments, brimonidine and brimonidine-timolol, during each of two 10-day study phases, was used. Four horses were randomly assigned to each of four combinations of treated eye (right or left) and drug order within the two 10-day study phases (brimonidine first or brimonidine-timolol first).

METHODS

Pupil size and conjunctival hyperaemia were assessed twice per day and IOP was measured three times per day using rebound tonometry in both eyes of 16 normal horses throughout two 10-day study periods (brimonidine and brimonidine-timolol) separated by an 18-day washout period. One eye of each horse was treated with brimonidine or brimonidine-timolol and the opposite eye was treated with balanced salt solution (BSS).

RESULTS

There were no adverse effects and no significant changes in pupil size in normal equine eyes treated with brimonidine or brimonidine-timolol. Average IOP in normal equine eyes treated with brimonidine (25.6 mmHg) was statistically higher than in eyes treated with brimonidine-timolol (24.6 mmHg) or BSS (24.5 mmHg). However, IOP differences were of ≤1 mmHg and thus not clinically important.

MAIN LIMITATIONS

Horses with normal eyes may not be as sensitive to the IOP-lowering effects of treatment as horses with glaucoma.

CONCLUSIONS

Brimonidine and brimonidine-timolol are well tolerated in normal horses but do not decrease IOP.

Intraocular pressure with rebound tonometry and effects of topical intraocular pressure reducing medications in guinea pigs

AIM

To investigate the intraocular pressure (IOP) of adult guinea pig eyes with rebound tonometry (RBT), and assess the effects of four distinctive topical IOP reducing medications including Carteolol, Brimonidine, Brinzolamide and Latanoprost.

METHODS

The IOPs of twenty-four 12-week-old guinea pigs (48 eyes) were measured every two hours in one day with RBT as baselines. All the animals were then divided into four groups (Carteolol, Brimonidine, Brinzolamide and Latanaprost groups, n=6). The IOPs were measured and compared to the baseline 1, 2, 3, 5, 7, 9, 15 and 24h after treatment.

RESULTS

The mean baseline IOP of 24 guinea pigs (48 eyes) was 10.3±0.36 mm Hg (6-13 mm Hg) and no binocular significant differences of IOPs were observed (t=1.76, P>0.05). No significant difference of IOP in Carteolol group at each time point was observed before and after treatment (t=1.48, P>0.05). In Brimonidine group, IOP was 2.2±1.9 mm Hg lower than the baseline after one hour (t=3.856, P=0.003) and lasted for one hour. In Brinzolamide group, IOP was 1.4±1.1 mm Hg lower than the baseline after one hour (t=4.53, P=0.001) and lasted for 7h and the IOP declined most at 3h. In Latanaprost group, IOP was 2.1±1.3 mm Hg lower than the baseline after one hour (t=6.11, P=0.001) and lasted for one hour.

CONCLUSION

The IOP of guinea pig eyes is relatively stable compared to human eyes. In four reducing IOP medications, no significant effect of Carteolol is observed. Brinzolamide has the longest duration, while the Brimonidine has the shortest duration and the maximum level of treatment.

Effect of timolol maleate gel-forming solution on intraocular pressure, pupil diameter, and heart rate in normal and glaucomatous cats

OBJECTIVE

To determine the effects of once-daily topical treatment with timolol maleate gel-forming solution (GFS) on intraocular pressure (IOP), pupil diameter (PD), and heart rate (HR) in normal cats and cats with feline primary congenital glaucoma (FCG).

ANIMALS STUDIED AND PROCEDURES

A single drop of timolol maleate 0.5% GFS was administered topically to one randomly assigned eye of 18 adult cats (8 normal, 10 FCG) at 8 am for 8 days; the opposite eye served as the untreated control. IOP was measured in both eyes (OU) every 2 h (PD and HR were measured every 4 h), for 14 h total, 1 day prior to and on days 1 and 8 of treatment. In a second treatment phase, a single drop of timolol was administered at 8 pm for 3 nights and IOP, PD, and HR were measured, as above, beginning at 8 am on day 4. Slit-lamp examinations were conducted prior to and after treatment phases. Comparisons of mean IOP, PD, and HR were made at each time point and between treated and untreated eyes by repeated-measures ANOVA and Tukey-Kramer post hoc test, with P < 0.05 considered significant.

RESULTS

Timolol maleate 0.5% GFS had an inconsistent effect on IOP, with maximum IOP-lowering effect (mean = 5.6 mmHg, 17.4%) observed 6 h post-treatment in FCG. The drug caused significant miosis (from 4 to 8 h post-treatment), but had no effect on HR.

CONCLUSION

Once-daily application of timolol maleate 0.5% GFS may be of limited clinical benefit in the management of feline congenital glaucoma.

Effect of preservative-free tafluprost on intraocular pressure, pupil diameter, and anterior segment structures in normal canine eyes

OBJECTIVE

This study was designed to evaluate the changes in intraocular pressure (IOP), pupil diameter (PD), and anterior segment parameters using ultrasound biomicroscopy (UBM) after instillation of preservative-free (PF) tafluprost in normal dogs.

PROCEDURES

Six beagle dogs were used. PF tafluprost was instilled in one randomly selected eye, and PF artificial tear was instilled in the other eye (control). IOP and PD were measured every 15 min for the first hour, every 2 h for the next 17 h, and at 24 h and 36 h postinstillation (PI). Anterior segment parameters including geometric iridocorneal angle (ICA), width of the entry of the ciliary cleft (CCW), length of the ciliary cleft, area of the ciliary cleft, and depth of the anterior chamber were measured with UBM before and after PF tafluprost instillation.

RESULTS

Compared with the control group, IOP was significantly lower from 4 h PI to 24 h PI and PD was significantly smaller from 30 min PI to 18 h PI (P < 0.05). Among UBM parameters, ICA and CCW significantly decreased and increased after PF tafluprost instillation, respectively (P < 0.05). Other parameters showed no significant changes.

CONCLUSIONS

Instillation of PF tafluprost lowered IOP and induced miosis in normal canine eyes. Alterations in ICA and CCW occurred simultaneously, which probably affected the outflow of aqueous humor. PF tafluprost could be considered an alternative prostaglandin analog in the treatment of canine glaucoma.

Effect of topical latanoprost 0.005% on intraocular pressure and pupil diameter in normal and glaucomatous cats

OBJECTIVE

To determine the effects of latanoprost on intraocular pressure (IOP) and pupil diameter (PD) in cats with inherited primary congenital glaucoma (PCG) and normal cats.

ANIMALS STUDIED AND PROCEDURES

IOP and PD were measured in both eyes (OU) of 12 adult cats (six normal, six PCG), three times per week for 3 weeks prior to, for 3 weeks during, and for 2 weeks following twice-daily treatment with 0.005% latanoprost to the right eye (OD) and vehicle to the left (control) eye (OS). IOP and PD were measured hourly, for 8 h, 1 day prior to, and on the first and last days of treatment. Aqueous humor flow rate (AHF) was determined at baseline and at the end of the treatment phase in six normal cats.

RESULTS

Mean IOP was significantly lower in treated vs. control eyes of PCG cats, for up to 8 h following a single latanoprost treatment, and a maximal IOP reduction of 63% occurred in treated eyes at 3 h. Latanoprost acutely lowered IOP in cats with PCG, but this effect appeared to diminish over 3 weeks of treatment. AHF was modestly increased in the treated eyes of normal cats after 3 weeks of latanoprost treatment, although IOP was not significantly affected. Latanoprost caused miosis, with rebound mydriasis at 24 h posttreatment, in the treated eyes of all cats.

CONCLUSIONS

Further research is needed to determine the suitability and efficacy of latanoprost treatment for long-term IOP-lowering in cats with PCG or other forms of glaucoma.

Glaucomas

Canine and feline glaucomas are commonly presented as ocular emergencies. Glaucoma is a common cause of vision loss and a frustrating disorder in terms of medical and surgical treatment. Increased intraocular pressure (IOP) is a significant risk factor in the disease, leading to damage of the retina and optic nerve head. IOP measurement and gonioscopic and fundic examinations provide the instruments for diagnosis of glaucoma. The primary goal in glaucoma therapy is aimed at vision preservation. Medical treatment provides temporary relief, but alone it fails to control IOP in the long term, and surgical intervention is recommended. Surgical patient selection depends on several factors, from type and stage of glaucoma to the presence of or potential for vision. Available surgical procedures to decrease IOP consist of cyclodestructive techniques to decrease aqueous humor production and filtering techniques to increase its drainage. Even with recent surgical and medical advances, pain and blindness are still common occurrences in the disease: end-stage procedures such as enucleation, evisceration with intrascleral prosthesis, and pharmacologic ablation of ciliary bodies are then recommended to address chronic discomfort for buphthalmic and blind globes.

Pharmacology of topical prostaglandin F2 α analogs and their place in the treatment of glaucoma in small animals

A distinguishing feature of the most common types of glaucoma is an increased intra-ocular pressure (IOP), which has a damaging effect on optic nerve axons, leading to the progressive loss of retinal ganglion cells. Therefore, IOP-lowering medications are the mainstay of glaucoma therapy. Topical prostaglandin F2 α analogs (PGAs) are a relatively new class of ocular hypotensive drugs, which have made a huge impact on the treatment of glaucoma in dogs. This study summarizes the current state of knowledge on the mechanism of action of these agents and their effect on IOP in dogs and cats. It also discusses potential harmful side effects of PGAs and presents contemporary opinions about their role and place in the medical management of glaucoma in small animals.

The effect of dorzolamide 2% on circadian intraocular pressure in cats with primary congenital glaucoma

OBJECTIVE

To determine the extent of fluctuation in circadian intraocular pressure (IOP) and the efficacy of topical dorzolamide 2% q 8 h in lowering IOP and blunting circadian fluctuation in IOP in glaucomatous cats.

ANIMALS STUDIED

Seven adult cats with primary congenital glaucoma (PCG).

PROCEDURES

Measurements of IOP and pupil diameter were obtained for both eyes (OU) of each cat q 4 h for 12 days. Cats were housed in a laboratory animal facility with a 12-h light:dark cycle. Baseline values were established for 2 days. For the next 5 days, placebo (1.4% polyvinyl alcohol) was administered OU q 8 h. Dorzolamide 2% was then administered OU q 8 h for a further 5 days. A multivariate mixed linear model was fitted to the data, with parameters estimated from a Bayesian perspective. The 4 am time point was selected as the reference for the purposes of comparisons.

RESULTS

Estimated mean IOP for the reference time point pre-treatment was symmetric (about 33 mmHg OU). In all cats, IOP was significantly lower during the diurnal phase, relative to the 4 am measurements, with highest IOP observed 2-6 h after the onset of the dark phase. Circadian fluctuations in IOP were dampened during the treatment period. There was a significant decrease in IOP in all cats during the dorzolamide treatment period (estimated mean for the treatment period reference = 17.9 mmHg OU).

CONCLUSIONS

Topical dorzolamide 2% q 8 h is effective in reducing IOP and IOP fluctuation in cats with PCG.

Topical application of 0.005% latanoprost increases episcleral venous pressure in normal dogs

INTRODUCTION

Episcleral venous pressure (EVP) has an important role in intraocular pressure (IOP) homeostasis and accounts for more than 70% of the IOP in the normal dog. A frequently used species in glaucoma research is the normotensive dog especially when evaluating the efficacy of prostaglandin analogues and prostamides; however, aqueous humor dynamic studies in normal dogs are lacking, and the effect of 0.005% latanoprost on canine EVP is not known. We sought to determine the effects to the EVP of topically applied 0.005% latanoprost in the normotensive beagle dog.

METHODS

Female beagle dogs (n = 14) were used and each had a normal ophthalmic examination on study entry. EVP was determined using a standard episcleral venomanometer. Animals were dosed in one eye with 0.005% latanoprost, and the effects on EVP were compared with the averaged baseline EVP's determined in the predosing phase and the fellow nondosed eye. The Mixed Model Repeated Measures method was used to analyze the EVP data.

RESULTS

During the dosing phase of the study with topical 0.005% latanoprost, the mean EVPs of dosed eyes were significantly higher than that of nondosed eyes (P < 0.0001).

CONCLUSIONS

The increase in EVP in the dog with exposure to topical 0.005% latanoprost has not been observed in other species that have been studied, such as in the mouse and in humans, where the drug had no significant effect on the EVP. This response may be unique to dogs and suggests that dogs may not fully mimic human aqueous humor dynamics with topical 0.005% latanoprost. Although frequently performed in human studies, EVP should not be regarded to be a constant value in aqueous humor dynamic studies in the normal beagle dog.

Feline glaucoma--a comprehensive review

Cats with glaucoma typically present late in the course of disease. It is likely that glaucoma in cats is under-diagnosed due to its insidious onset and gradual progression, as well as limitations of some commonly used tonometers in this species. Treatment of glaucoma in feline patients presents a clinical challenge, particularly as glaucoma is often secondary to other disease processes in cats. In this review, we consider the clinical features, pathophysiology, and classification of the feline glaucomas and provide current evidence to direct selection of appropriate treatment strategies for feline glaucoma patients.

Effect of topical 0.03% flurbiprofen and 0.005% latanoprost, alone and in combination, on normal canine eyes

OBJECTIVE

Evaluate the influence of topically applied flurbiprofen 0.03% and latanoprost 0.005%, alone or in combination, in normal canines.

ANIMALS STUDIED

  10 Normal Beagles.

PROCEDURES

Intraocular pressure (IOP), pupil size, aqueous flare, conjunctival hyperemia, and blepharospasm were evaluated bilaterally five times daily (8 am, 11 am, 2 pm, 5 pm, and 8 pm). The study consisted of a training and acclimation period, followed by 3, 1-week experiment periods. A 2-week washout period occurred between each experiment period. During period 1, all dogs received flurbiprofen (three doses 6-h apart) in the treated eye, whereas in period 2, all dogs received latanoprost (one dose 24-h apart). During period 3, both latanoprost (one dose 24-h apart) and flurbiprofen (three doses 6-h apart) were administered in the treated eye.

RESULTS

Flurbiprofen resulted in a mean IOP elevation of 1.1 mmHg (8.65%) in the treated eye, as compared with the control eye. No effect on pupil size, conjunctival hyperemia, or aqueous flare was noted. Latanoprost resulted in a mean IOP reduction of 3.4 mmHg (30.19%). Combined latanoprost and flurbiprofen resulted in a mean IOP reduction of 2.7 mmHg (24.56%). Miosis was noted in the treated eyes during both latanoprost periods, with maximal pupil constriction 3-h post-dose. This was followed by relative mydriasis 24-h post-dose, persisting 48 h after the last dose. The degree of conjunctival hyperemia varied between individuals. Neither blepharospasm nor aqueous flare was noted at any time point.

CONCLUSION

Concurrent administration of latanoprost and flurbiprofen resulted in a 20.41% reduction in the ocular hypotensive effect relative to latanoprost therapy alone.

Effects of topical administration of latanoprost, timolol, or a combination of latanoprost and timolol on intraocular pressure, pupil size, and heart rate in clinically normal dogs

OBJECTIVE

To determine effects after topical administration of latanoprost, timolol, or a commercially available latanoprosttimolol combination twice daily on intraocular pressure (IOP), pupil size (PS), and heart rate (HR) in clinically normal dogs.

ANIMALS

17 clinically normal dogs.

PROCEDURES

A randomized controlled clinical trial was performed with a treatment (n=9) and saline (0.9% NaCl) solution group (8). Each dog in the treatment group received 3 treatments (latanoprost, timolol, and the latanoprost-timolol combination), with a 14-day washout period between treatments. Baseline values were established on day 1 of each treatment period. On days 2 through 5, drugs were administered topically every 12 hours to 1 eye of each dog in the treatment group. In both groups, IOP PS, and HR were measured at 0, 2, 4, 6, 8, and 9 hours on days 2 and 5.

RESULTS

Eyes treated with latanoprost or the latanoprost-timolol combination had a significant decrease in IOP and a significantly smaller PS, compared with results for dogs receiving only timolol or dogs in the saline solution group. Timolol and the latanoprost-timolol combination both significantly lowered HR, compared with HR following administration of latanoprost and the saline solution.

CONCLUSIONS AND CLINICAL RELEVANCE

Topical administration of latanoprost alone was as effective at lowering IOP as was administration of the latanoprost-timolol combination when both were given every 12 hours to clinically normal dogs. Timolol, either alone or in combination with latanoprost, appeared to have little or no effect on IOP in clinically normal dogs but was associated with a reduction in HR.

Short-term effects of topical tafluprost on retinal blood flow in cats

PURPOSE

The aim of this study was to determine the short-term effects of topical tafluprost, a novel prostaglandin F(2) derivative, on feline retinal circulation.

METHODS

Seventeen (17) adult cats were anesthetized with enflurane and mechanically ventilated. One (1) drop of tafluprost (0.0015%; n = 8), latanoprost (0.005%; n = 5), or control vehicle (n = 4) was instilled in 1 eye and the fellow eye was untreated. We measured the intraocular pressure (IOP), vessel diameter, and blood velocity simultaneously for 120 min in the large retinal arterioles and calculated the retinal blood flow (RBF) with a laser Doppler velocimetry system.

RESULTS

Tafluprost 0.0015% significantly increased RBF (maximum change, 42.8 +/- 4.2% [mean +/- standard error of the mean; P < 0.01) and blood velocity (maximum change, 24.1 +/- 3.3%; P < 0.01) for 120 min after instillation; there was no significant change in vessel diameter. Latanoprost 0.005% significantly increased RBF (maximum change, 31.7 +/- 3.4%; P < 0.05); there was no significant change in vessel diameter and blood velocity. There were no significant differences in the IOP reduction among the three groups.

CONCLUSIONS

We observed, for the first time, that topical tafluprost significantly increased RBF in cats, suggesting that dual-action tafluprost may be a beneficial antiglaucomatous agent for reducing IOP and increasing RBF.

Effects of topical levobunolol or fixed combination of dorzolamide-timolol or association of dorzolamide-levobunolol on intraocular pressure, pupil size, and heart rate in healthy cats

The effects of topical levobunolol with the fixed combination of 2% dorzolamide-0.5% timolol and the association of 2% dorzolamide with 0.5% levobunolol on intraocular pressure (IOP), pupil size (PS), heart rate (HR), and conjunctival hyperemia in eighteen halthy cats were investigated and compared. IOP, PS, HR, and conjuntival hyperemia were daily recorded at three times (9a.m., 2p.m., and 6p.m.). Three groups were formed (n=6), and one eye of each animal was randomly selected and treated with topical levobunolol (L), or commercial combination of dorzolamide-timolol (DT), or the association of dorzolamide with levobunolol (DL). The first day (0) consisted of recording of baseline values. On the next four consecutive days, drugs were instilled at 8a.m. and 8p.m. and measurements were taken at the same times fore cited. Comparing with the baseline values, all evaluated parameters significantly decreased (P<0.001). Conjuntival hyperemia was not seen. Levobunolol significantly declined IOP, PS, and HR in normal cats, and showed a stronger effect in lowering HR, when compared to dorzolamide-timolol effect. No synergistic effect in IOP declining was noted when levobunolol dorzolamide was added to levobunolol.

Feline primary open angle glaucoma

OBJECTIVES

We have documented the histomorphological features of feline primary open angle glaucoma.

DESIGN

A retrospective morphologic study of eight affected eyes from eight cats, from 1992 to 2006 extracted from a pathology collection, which includes 4000 feline submissions and 1100 cases of feline glaucoma.

PROCEDURE

Sections of affected globes, stained with H&E or with alcian blue were examined with a light microscope. Eyes that did not fulfill the criteria for primary open angle glaucoma were excluded from the study.

RESULTS

The mean age was 9.1 years. Five cats were female and three cats were male. The breeds included five DSH, two Burmese, and one DLH cat. Significant histomorphological findings included an open irido-corneal angle with an open ciliary cleft in all cases, loss of ganglion cells in eight of eight cases, cupping and gliosis of the optic nerve head in four of four cases in which the optic nerve was adequately sampled, and myxomatous changes of the stroma surrounding the vortex veins in seven of eight cases.

CONCLUSIONS

Primary open angle glaucoma in cats is a rare disease that should be taken into consideration when investigating cases of feline glaucoma. The pathogenesis of aqueous outflow obstruction in these cases is not known. This study describes eight additional cases of feline primary open angle glaucoma in cats without an identified cause.

Goniodysgenesis associated with primary glaucoma in an adult European Short-haired cat

A 9.5-year-old, male castrated European Short-haired (ESH) cat was presented with bilateral glaucoma associated with pectinate ligament dysplasia and an open iridocorneal angle (ICA) upon gonioscopy. The right eye (OD) was avisual and slightly enlarged; the left eye (OS) was still visual. Intraocular pressure (IOP) had been controlled with medical therapy over a 1.5 year-period in both eyes (OU). Eventually IOP could not be adequately controlled medically and the painful and blind right eye was enucleated and transscleral diode laser cyclophotocoagulation was performed twice in the left eye with less than optimal results and progressive loss of vision. Histopathology of the right eye showed goniodysgenesis characterized by failure of differentiation of the pectinate ligament, which existed as a solid sheet of uveal tissue at the entrance of a hypoplastic ciliary cleft, which contained loose mucoid mesenchymal tissue. The trabecular meshwork was hypoplastic and the scleral venous plexus could not be identified. Other findings of chronic glaucoma were inner retinal atrophy, optic nerve atrophy with disc cupping, scleral thinning, peripheral corneal vascularization and pigmentation, and mild focal iridal mononuclear inflammatory cell infiltrate.

Ocular effects of topical 0.03% bimatoprost solution in normotensive feline eyes

OBJECTIVE

The current study was undertaken to evaluate the effects of topically applied bimatoprost, an ocular hypotensive lipid, on intraocular pressure (IOP) and pupil size (PS) in healthy cats.

ANIMAL STUDIED

Nine European Shorthair cats free from clinically relevant ocular abnormalities were used in the study.

PROCEDURES

Pretreatment baseline measurements of IOP and PS were obtained bilaterally at 8 am, 2 pm, and 8 pm for five consecutive days (days 1 to 5). Then the cats received one drop twice daily (10 am and 6 pm) of bimatoprost ophthalmic solution 0.03% (Lumigantrade mark, Allergan Inc., Irvine, CA USA), in one randomly selected eye and one drop of artificial tears in the fellow eye (control eye) for 5 days (days 6 to 10). Values for IOP and PS were obtained under the same conditions as in the pretreatment phase. The potential for ocular irritation following bimatoprost application was also evaluated.

RESULTS

During the pretreatment period, the mean IOP and mean PS were not significantly different between the eyes subsequently treated with bimatoprost and those subsequently determined as controls. During the treatment period, the mean IOP in bimatoprost-treated eyes was not significantly lower than in control eyes (14.2+/-2.3 vs. 14.5+/-2.8 mmHg). Mean IOP in control eyes was not significantly changed at any time during the study period. A marked reduction of PS was seen in all bimatoprost-treated eyes, but no other clinically relevant side effects were observed.

CONCLUSION

Twice daily topical applications of bimatoprost produced miosis but had no significant effect on IOP in healthy cats.

Effects of travoprost 0.004% compared with latanoprost 0.005% on the intraocular pressure of normal dogs

PURPOSE

To compare the effects of travoprost 0.004% and latanoprost 0.005% on the intraocular pressure (IOP) of normal dogs.

METHODS

Twenty mixed breed dogs were randomized to two groups: latanoprost was used in group A and travoprost in group B. The drugs were instilled in the right eye of the dogs, whereas the left eye received placebo. Both drugs were instilled once a day at 8 am during 5 days. IOP measurements were made at 8 am, 10 am, 2 pm and 8 pm during the 5 days of treatment, the 3 days that preceded treatment, and 3 days following treatment. Presence of blepharospasm, miosis, anterior chamber flare, and conjunctival hyperemia were evaluated during the study.

RESULTS

Mean IOP was significantly reduced in the eyes treated with both latanoprost and travoprost, when compared with the eyes treated with placebo (P<0.05). There was no statistically significant difference between the mean IOPs of eyes treated with latanoprost and travoprost at all time intervals during baseline, treatment, and recovery (P>0.05). On the fifth day of treatment and on the first day of the recovery period, a severe ocular hypotension was noted with both drugs, resulting in imprecise readings with the tonometer. Miosis and conjunctival hyperemia were observed in the treated eyes of both groups, whereas flare was noticed in one latanoprost-treated eye.

CONCLUSION

Travoprost 0.004% significantly reduces the IOP in normal dogs. The hypotensive effect obtained with travoprost 0.004% is comparable to that obtained with latanoprost 0.005%.

Putative aqueous humor misdirection syndrome as a cause of glaucoma in cats: 32 cases (1997-2003)

OBJECTIVE

To characterize the clinical and morphologic aspects of aqueous humor misdirection syndrome (AHMS) in cats and provide a hypothesis regarding its pathogenesis on the basis of detailed analysis of affected cats.

DESIGN

Retrospective study.

ANIMALS

32 cats (40 eyes).

PROCEDURE

Medical records of cats in which AHMS was diagnosed from July 1997 to August 2003 were reviewed. In certain cats, results of additional diagnostic testing were also obtained, including A-scan, B-scan, and high-resolution ultrasonography; streak retinoscopy; video keratometry; and infrared neutralizing videoretinoscopy as well as results of analysis of flash-frozen sections and histologic examination of enucleated globes.

RESULTS

Cats had a uniformly shallow anterior chamber, intact lens zonules, and a narrowed approach to an open iridocorneal angle. Mean age of affected cats was 11.7 years (range, 4 to 16 years), and female cats were significantly more often affected than male cats. Clinical signs included mydriasis, decreased pupillary light reflex, decreased menace response, and blindness. Glaucomatous changes to the optic nerve, incipient cataracts, and eventual blindness were seen. Intraocular pressure was > or = 20 mm Hg (range, 12 to 58 mm Hg) in 32 of 40 eyes. Ultrasonography and histologic examination revealed a thickened anterior vitreal face interposed between the lens and ciliary body, partial ciliary cleft collapse, and cavitated vitreal regions. Various treatment modalities were used.

CONCLUSIONS AND CLINICAL RELEVANCE

AHMS affects older cats, especially females, and may result in glaucoma, vision loss, and signs of ocular pain. Topical administration of carbonic anhydrase inhibitors decreased intraocular pressure.

The effects of bimatoprost and unoprostone isopropyl on the intraocular pressure of normal cats

OBJECTIVE

To evaluate the effects on intraocular pressure (IOP), pupillary diameter (PD), blepharospasm score, conjunctival injection score, and aqueous humor flare score when either 0.03% bimatoprost solution is applied once daily or 0.15% unoprostone isopropyl solution is applied twice daily topically to the eyes of normal cats.

MATERIALS AND METHODS

The aforementioned parameters were evaluated daily in each of 12 cats throughout the entirety of the study. During an initial 10-day treatment phase a single eye of six of the cats was treated with 0.03% bimatoprost solution while a single eye of the remaining six cats was treated with buffered saline solution (BSS) once daily. During a second 10-day treatment phase a single eye of six of the cats was treated with 0.15% unoprostone isopropyl solution while a single eye of the remaining six cats was treated with BSS twice daily. Contralateral eyes of all cats remained untreated at all time points.

RESULTS

Blepharospasm score, conjunctival injection score, and aqueous humor flare score never rose from a value of 0, for any eye of any cat during the study. The mean +/- SD of IOP for eyes treated with 0.03% bimatoprost solution and BSS were 16.55 +/- 3.06 mmHg and 18.02 +/- 3.52 mmHg, respectively. The mean +/- of PD for eyes treated with 0.03% bimatoprost solution and BSS were 5.7 +/- 1.57 mm and 6.39 +/- 1.78 mm, respectively. The mean +/- SD of IOP for eyes treated with 0.15% unoprostone isopropyl solution and BSS were 15.7 +/- 2.91 mmHg and 17.2 +/- 2.9 mmHg, respectively. The mean +/- SD of PD for eyes treated with 0.15% unoprostone isopropyl solution and BSS were 5.8 +/- 1.43 mm and 6.9 +/- 1.37 mm, respectively. There was no significant difference (P > or = 0.05) in IOP or PD between eyes treated with 0.03% bimatoprost solution vs. eyes treated with BSS. Similarly, there was no significant difference (P > or = 0.05) in IOP or PD between eyes treated with 0.15% unoprostone isopropyl solution vs. eyes treated with BSS.

CONCLUSION

Neither once daily topical administration of 0.03% bimatoprost solution nor twice daily topical administration of 0.15% unoprostone isopropyl solution significantly affect the IOP of normal cats. Both 0.03% bimatoprost solution and 0.15% unoprostone isopropyl solution induced no significant ocular side effects in normal cats when dosed over a 10-day treatment period.

Feline glaucomas

Cats are usually presented at a very late stage in the course of glaucoma when the eye is already blind. Secondary glaucoma because of another underlying ocular lesion is the most common form of glaucoma in the cat and is frequently associated with chronic anterior uveitis or intraocular neoplasia. Chronic stages of glaucoma in the cat are characterized by buphthalmus, anterior lens luxation, and exposure keratitis secondary to the enlarged globe. Ophthalmoscopic signs of glaucomatous retinal degeneration are only noticed in very advanced stages. Treatment of glaucoma in cats is usually aimed to keep the eye comfortable and within a normal intraocular pressure range. However, many antiglaucoma medications that are successfully used in humans and dogs are not very well tolerated by cats and, therefore, the selection of recommended drugs is limited in this species.

Effect of Different Dose Schedules of 0.15% Unoprostone Isopropyl on Intraocular Pressure and Pupil Size in the Glaucomatous Beagle

The changes in intraocular pressure (IOP) and pupil size (PS) after instillations of 0.15% unoprostone isopropyl (Rescula, Novartis Ophthalmics, Duluth, GA) were investigated in the spontaneous glaucoma Beagle model. From the first-day baseline IOP of 27.3+/-3.2 mmHg placebo eye and 32.8+/-5.1 mmHg control eye, the mean+/-standard error of the mean (SEM) diurnal changes after 0.15% unoprostone, at 8 AM once-daily for the next 4 days, were 15.5+/-1.3 mmHg, 14.7+/-1.9 mmHg, 16.1+/-1.1 mmHg, and 17.0+/-1.5 mmHg, respectively, and were significantly different from the control eye. After 0.15% unoprostone was instilled at 8 PM, the mean+/-SEM baseline changes from the baseline IOP (insert drug eye 9 AM) in the drug eyes were 5.9+/-2.5 mmHg, 5.2+/-4.1 mmHg, 9.7+/-2.5 mmHg, and 3.6+/-3.6 mmHg, respectively. When 0.15% unoprostone was instilled twice-daily, the mean+/-SEM baseline IOP (insert drug eye 9 AM) changes were 13.6+/-0.7 mmHg, 13.9+/-1.4 mmHg, 11.3+/-1.0 mmHg, and 9.3+/-1.4 mmHg, respectively, and were significantly different from the control eyes. Miosis occurred within 2 hours and lasted several hours. Unoprostone isopropyl instilled once-daily (AM or PM), as well as twice-daily, produces significant decreases in IOP and PS in the glaucomatous Beagle.

Ocular hypotensive drugs

The glaucomas are vision-threatening diseases that commonly result in blindness. In addition to knowledge of the at-risk breeds and predisposing factors for glaucoma as well as the clinical signs of the disease, regular IOP screening with tonometry is required to confirm glaucoma and to monitor the status of the eye. Early intervention with a combination of medications that are capable, in a given species, of reducing aqueous production and increasing aqueous outflow as well as potentially reducing progressive neurosensory degeneration is key to the medical management of this disease.