Prostaglandin-Induced Macular Hole: A Brief Report

This case series reports on two patients who developed macular holes while on prostaglandin analogs (PGA) therapy. The first case involves a 63-year-old woman with a history of a macular hole of the left eye that had spontaneously closed. After starting PGA therapy for elevated intraocular pressure, cystoid macular edema formed, which resulted in reopening of the macular hole. The second case involves a 64-year-old man with primary open-angle glaucoma, on PGA therapy, with a newly diagnosed small macular hole of the right eye that closed after cessation of the PGA therapy. These cases demonstrate an association between prostaglandin analogs and the formation or reopening of full-thickness macular holes. [Ophthalmic Surg Lasers Imaging Retina 2024;55:112-115.].

Comparing the effect of benzalkonium chloride-preserved, polyquad-preserved, and preservative-free prostaglandin analogue eye drops on cultured human conjunctival goblet cells

PURPOSE

To investigate the effect of benzalkonium chloride (BAK)-preserved latanoprost and bimatoprost, polyquad (PQ)-preserved travoprost, and preservative-free (PF) latanoprost and tafluprost, all prostaglandin analogues (PGAs), on human conjunctival goblet cell (GC) survival. Furthermore, to investigate the effect of BAK-preserved and PF latanoprost on the cytokine secretion from GC.

METHODS

Primary human conjunctival GCs were cultivated from donor tissue. Lactate dehydrogenase (LDH) and tetrazolium dye colorimetric (MTT) assays were used for the assessment of GC survival. A cytometric bead array was employed for measuring secretion of interleukin (IL)-6 and IL-8 from GC.

RESULTS

BAK-preserved latanoprost and bimatoprost reduced cell survival by 28% (p = 0.0133) and 20% (p = 0.0208), respectively, in the LDH assay compared to a negative control. BAK-preserved latanoprost reduced cell proliferation by 54% (p = 0.003), BAK-preserved bimatoprost by 45% (p = 0.006), PQ-preserved travoprost by 16% (p = 0.0041), and PF latanoprost by 19% (p = 0.0001), in the MTT assay compared to a negative control. Only PF tafluprost did not affect the GCs in either assay. BAK-preserved latanoprost caused an increase in the secretion of pro-inflammatory IL-6 and IL-8 (p = 0.0001 and p = 0.0019, respectively) compared to a negative control, which PF latanoprost did not.

CONCLUSION

BAK-preserved PGA eye drops were more cytotoxic to GCs than PQ-preserved and PF PGA eye drops. BAK-preserved latanoprost induced an inflammatory response in GC. Treatment with PF and PQ-preserved PGA eye drops could mean better tolerability and adherence in glaucoma patients compared to treatment with BAK-preserved PGA eye drops.

Prostaglandin FP receptor agonists in the treatment of glaucoma and ocular hypertension: a literature review

INTRODUCTION

Glaucoma is a leading cause of blindness with intraocular pressure (IOP) as the only known modifiable risk factor. Prostaglandin FP receptor agonists are the first-line medical treatment for glaucoma and ocular hypertension. Despite their efficacy, their IOP lowering effect may be insufficient requiring second agents, and poor patient compliance to medical therapy may preclude their full effect.

AREAS COVERED

This literature review examines the novel FP receptor drugs and drug delivery devices in clinical phase trials for treatment of glaucoma. Three novel drugs targeting FP receptors were identified, including latanoprostene bunod, NCX 470, and sepetaprost. Additionally, sustained drug delivery devices in early clinical phase trials included intracameral implants, punctal plugs, ocular rings, and contact lenses.

EXPERT OPINION

NO hybrid FP receptor agonists and dual FP/EP3 receptor agonists may show promise as novel medical therapies with greater efficacy than approved prostaglandin analogs in clinical use, with a similar safety profile. Alternatively, drug delivery systems may provide a similar IOP lowering effect to existing agonists but overcome issues with patient compliance and convenience. A personalized approach to drug delivery devices may be required to ensure the most appropriate fit for the patient according to the invasiveness and duration of therapy desired.

Association between personality traits and experience of adverse periocular reactions to topical prostaglandin analogues

Background

Aesthetically unappealing adverse periocular reactions to prostaglandin (PG) eye-drops are a major challenge in glaucoma treatment. This study analysed the personality traits of patients with glaucoma based on a five-factor model and examined the associations between these factors and adverse periocular reactions.

Methods

One hundred and forty-seven patients with glaucoma were surveyed anonymously regarding their personality traits and how often adverse periocular reactions were experienced.

Results

The analysis included 117 valid responses (71 men and 46 women, age: 61.9±11.5 years). Patients who experienced hypertrichosis of the eyelashes scored significantly higher on extraversion (p<0.05), with no significant differences in the other four personality traits. Patients who experienced eyelid hyperpigmentation and deepening of the upper eyelid sulcus showed no significant differences in any of the personality traits. Younger patients scored significantly higher on hypertrichosis (p<0.05).

Conclusion

The experience of adverse reactions differed according to patient age and personality traits. Therefore, eye-drops should be chosen based on these factors.

Trial registration number

UMIN000035155.

The risk of uveitis due to prostaglandin analogs in pediatric glaucoma

PURPOSE

To examine the incidence of uveitis in children prescribed prostaglandin analogs (PGAs) for glaucoma.

METHODS

In this dual-center cohort study, the medical records of consecutive patients <18 years old treated with a PGA between January 1, 2012, and December 31, 2018, were reviewed retrospectively. Patients with all forms of glaucoma, including those with a prior history of uveitis, were included. Patients who had been on a PGA prior to their first recorded visit were excluded. Patient charts were reviewed for new or recurrent uveitis during the first year of PGA therapy.

RESULTS

A total of 103 children (147 eyes) were included, with a total PGA exposure of 1,352 child-months. Ninety-eight children (142 eyes) tolerated the PGA without an episode of uveitis. Five patients with a documented prior history of uveitis experienced a unilateral episode of uveitis. A review of their medical records identified prescribed or unscheduled decrease in topical steroids or immunosuppressive medication as the most likely cause of uveitis recurrence.

CONCLUSIONS

This study provides further evidence that PGAs are unlikely to induce uveitis in children being treated for glaucoma and suggests that this may also be true in those with a history of uveitis. We are unable to evaluate whether PGAs make recurrence more likely or the tapering of steroids more difficult.

Proposal of a simple grading system integrating cosmetic and tonometric aspects of prostaglandin-associated periorbitopathy

The distribution of prostaglandin-associated periorbitopathy (PAP) graded using the Shimane University PAP Grading System (SU-PAP) among glaucoma/ocular hypertension subjects using a topical FP or EP2 receptor agonist was reported. A 460 consecutive 460 Japanese subjects (211 men, 249 women; mean age ± standard deviation, 69.9 ± 14.5 years) who had used either a FP agonist (0.005% latanoprost, 0.0015% tafluprost, 0.004% travoprost, 0.03% bimatoprost, or fixed combinations of these) or EP2-agonist (0.002% omidenepag isopropyl) for more than 3 months in at least 1 eye were retrospectively enrolled. Age, sex, prostaglandin, intraocular pressure (IOP) measured by Goldmann applanation tonometry (IOPGAT) and iCare rebound tonometry (IOPRBT), difference between IOPGAT and IOPRBT (IOPGAT-RBT), PAP grade, and PAP grading items were compared among groups stratified by PAP grade or prostaglandins. Of the study patients, 114 (25%) had grade 0 (no PAP), 174 (38%) grade 1 (superficial cosmetic PAP), 141 (31%) grade 2 (deep cosmetic PAP), and 31 (7%) grade 3 (tonometric PAP). The IOPGAT was significantly higher in grade 3 (17.5 ± 5.4 mm Hg) than grades 0 (15.0 ± 5.1 mm Hg, P = .032) and 1 (14.5 ± 4.2 mm Hg, P = .008), and the IOPGAT-RBT was significantly higher in grade 3 (5.8 ± 3.2 mm Hg) than the other 3 grades (1.3-1.9 mm Hg, P < .001 for all comparisons); the IOPRBT was equivalent among the 4 grades. The PAP grade was significantly higher associated with travoprost (2.0 ± 0.8) and bimatoprost (2.0 ± 0.7) than latanoprost (1.0 ± 0.8, P < .001 for both comparisons) and tafluprost (1.0 ± 0.7, P < .001 for both comparisons), but significantly lower associated with omidenepag (0.0 ± 0.0, P < .001 for all comparisons) than the other 4 prostaglandins. Multivariate analyses showed older age (standard β = 0.11), travoprost (0.53, referenced by latanoprost) and bimatoprost (0.65) were associated with higher PAP grades, while tafluprost (-0.18) and omidenepag (-0.73) were associated with lower PAP grades. The PAP graded using SU-PAP reflects the degree of overestimation of the IOPGAT and different severities of PAP among the different prostaglandins. SU-PAP, the grade system constructed based on the underlining mechanisms of PAP, is a simple grading system for PAP that is feasible for use in a real-world clinical situation.

Uveitis and cystoid macular oedema secondary to topical prostaglandin analogue use in ocular hypertension and open angle glaucoma

BACKGROUND

Of the side effects of prostaglandin analogues (PGAs), uveitis and cystoid macular oedema (CME) have significant potential for vision loss based on postmarket reports. Caution has been advised due to concerns of macular oedema and uveitis. In this report, we researched and summarised the original data suggesting these effects and determined their incidence.

METHODS

Preferred Reporting Items for Systematic review and Meta-Analyses guidelines were followed. Studies evaluating topical PGAs in patients with ocular hypertension or open angle glaucoma were included. MEDLINE, PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, LILACS and ClinicalTrials.gov were searched between 1946 and 2019. Experimental studies, animal studies and randomised studies with other intraocular pressure-lowering eye drops were excluded.

RESULTS

214 studies (28 232 patients) met the inclusion criteria. Using prospective data, the incidence of uveitis and CME among PGA users were 62/28 232 (0.22%) and 25/28 232 (0.09%), respectively. A higher frequency of both uveitis and CME were found among latanoprost users compared with bimatoprost. There were 21 case studies reporting CME including 48 eyes in 43 patients. 47 of 48 eyes (97.9%) had previous incisional ocular surgery. 8 eyes were re-challenged, of which 7 (87.5%) recurred. 7 case studies reported uveitis in 15 eyes of 10 patients. 7 of 15 eyes (46.7%) were either pseudophakic or aphakic. 6 eyes were re-challenged, and all 6 (100%) recurred.

CONCLUSIONS

Cases of uveitis or CME revealed a confounding effect of ocular surgery, aphakia or subluxed intraocular lens. PGAs may be used in non-surgical patients without concern of causing CME or uveitis. The incidences of PGA-associated CME and uveitis are rare with limited prospective studies on the cause-effect relationship.

Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management

Cystoid macular edema (CME) is a form of macular retina thickening that is characterized by the appearance of cystic fluid-filled intraretinal spaces. It has classically been diagnosed upon investigation after a decrease in visual acuity; however, improvements in imaging technology make it possible to noninvasively detect CME even before a clinically significant decrease in central vision. Risk factors for the development of CME include diabetic retinopathy, retinal vein occlusion, uveitis, and cataract surgery. It has been proposed that eyes with elevated intraocular pressure after cataract surgery, including those treated with prostaglandin analog eye drops, may be at higher risk for the development of CME. We summarize the current knowledge of the molecular mechanisms underlying CME, the potential role of ocular surgery and topical glaucoma medication in increasing the risk of CME, the newly developed imaging methods for diagnosing CME, and the clinical management of CME.

Shortening of Interpupillary Distance after Instillation of Topical Prostaglandin Analog Eye Drops

PURPOSE

To investigate changes in the interpupillary distance (IPD) after continual instillation of topical prostaglandin analogs (PGAs) in glaucoma patients as an objective indicator of prostaglandin-associated periorbitopathy (PAP).

DESIGN

Retrospective, comparative case series.

METHODS

A total of 152 institutional patients with glaucoma were enrolled in this study. Inclusion criteria were visual acuities exceeding 10/20 bilaterally and no intraocular surgery during observation. Intervention/observation procedures: First-time bilateral instillation of bimatoprost, travoprost, latanoprost, or tafluprost and IPDs measured by automatic refractometry. IPDs, intraocular pressures (IOPs), and refractive errors were measured before and after continual drug administration (treatment, 2-24 months).

MAIN OUTCOME MEASUREMENTS

Post-treatment changes in IPDs. A total of 61 untreated patients served as controls.

RESULTS

The IPDs shortened significantly (P < 0.001) after treatment (-0.80 ± 2.1 mm); the IPDs of control subjects remained unchanged (0.05 ± 0.96 mm; P = 0.69). The IPD change after bimatoprost instillation (-2.20 ± 0.97 mm) was significantly (P < 0.001) greater than with other PGAs (-0.65 ± 2.09 mm). The IOPs decreased significantly (P < 0.001) (-3.7 ± 4.3 mm Hg); the refractive errors did not change significantly (P < 0.099) (-0.07 ± 0.69 diopter) post-treatment. The percentages of subjects with 2-mm or greater decreases in IPD after bimatoprost, travoprost, latanoprost, or tafluprost were 85.7%, 20.0%, 18.2%, and 17.2%, respectively, and with 3-mm or greater decreases in IPD 35.7%, 12.0%, 14.5%, and 12.1%, respectively. The specificities were 93.4% and 100% in the control group, respectively, with IPD threshold changes of 2 and 3 mm or more, respectively.

CONCLUSIONS

The IPD decreased significantly after topical PGAs within 24 months. The effect was significantly greater with bimatoprost than with other PGAs. The noninvasive, immediate automatic refractometry measurement may be an objective numerical indicator of PAP.

Laser eye procedure is safe and effective as an early treatment for glaucoma

The studyGazzard G, Konstantakopoulou G, Garway-Heath E, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet 2019; doi:10.1016/S0140-6736(18)32213-XThis project was funded by the NIHR Health Technology Assessment Programme (project number 09/104/40) and was sponsored by the Moorfields Eye Hospital NHS Foundation Trust.To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000774/early-glaucoma-laser-eye-treatment-trabeculoplasty.

Topical prostaglandin analogues and development of epiretinal membrane

OBJECTIVES

To determine whether patients with glaucoma and epiretinal membrane (ERM) use a greater proportion of prostaglandin analogues (PA) than a control group of patients with glaucoma without ERM.

METHOD

A retrospective study of cases and controls was conducted in order to determine whether patients with glaucoma and ERM used a greater proportion of PA than a control group of patients with glaucoma without ERM. The diagnosis of de ERM was made by clinical examination and optical coherence tomography.

RESULTS

The mean age of the cases was 77 years (SD: 8.68; 95% CI: 74.3-79.4), compared to the controls with 63 years (SD: 16.6; 95% CI: 70.1-78.5). The cases included 50% (n=26) men and 50% women (n=26), whereas in the controls 25.4% (n=16) of the cases were men and 74.6% (n=47) women. PA treatment was used in 59.6% (n=31) and 60.3% (n=38) of the cases and controls, respectively. There was no statistically significant difference in PA use between the 2groups (P=.939).

CONCLUSIONS

In this study, an association between the use of AP and the development of ERM could not be demonstrated.

Prospective Observational Post-Marketing Study of Tafluprost for Glaucoma and Ocular Hypertension: Effectiveness and Treatment Persistence

INTRODUCTION

The aim of this study was to investigate the long-term intraocular pressure (IOP)-lowering effect and safety of tafluprost, a prostaglandin analogue, in actual clinical practice and to determine persistency of tafluprost as an indicator of its benefit-risk balance.

METHODS

This was a large-scale, post-marketing, multicenter, non-interventional, open-label, long-term study. Patients with glaucoma or ocular hypertension who initiated tafluprost treatment were registered and prospectively observed over a 2-year period in the real-world setting in Japan. Long-term IOP and safety data were collected.

RESULTS

Of the 4502 patients registered from 553 medical institutions, 4265 patients were analyzed. The majority of patients had normal-tension glaucoma (44.4%) and primary open-angle glaucoma (37.8%), and patients with ocular hypertension constituted 7.0%. Treatment patterns with tafluprost during the study period were as follows: naïve monotherapy (48.1%), switching monotherapy (18.4%), and concomitant therapy (33.5%). In all patients analyzed, mean IOP was significantly reduced from 18.6 ± 5.9 mmHg (month 0) to 15 mmHg or below throughout the 2-year observation period after initiation of tafluprost. Significant IOP-lowering effects were shown in various treatment patterns and disease types. Adverse reactions were observed in 795 patients (18.64%). Major adverse reactions included eyelid pigmentation, ocular hyperemia, eyelash changes, eyelid hypertrichosis, and iris hyperpigmentation. Kaplan-Meier curves showed that 84.6% and 76.1% of patients were persistent on tafluprost for 1 and 2 years, respectively, when discontinuation due to insufficient efficacy or adverse events was defined as a treatment failure event. Furthermore, among treatment-naïve patients (n = 2304), the persistency rates on tafluprost monotherapy were 77.0% for 1 year and 67.0% for 2 years.

CONCLUSION

Tafluprost showed significant long-term IOP-lowering effects regardless of treatment patterns or diagnosis, with minimum safety concerns in the actual clinical practice. The observed treatment persistence suggests that tafluprost can be used long term owing to its benefit-risk profile.

FUNDING

Santen Pharmaceutical Co., Ltd., Osaka, Japan.

Factors Related to Prostaglandin-Associated Periorbitopathy in Glaucoma Patients

PURPOSE

To determine factors related to prostaglandin-associated periorbitopathy (PAP) and its prevalence in glaucoma or ocular hypertension (OHT) patients using prostaglandins analogs (PGAs).

DESIGN

A cross-sectional study.

METHODS

A study of glaucoma or OHT patients, using topical PGAs for at least 3 months, was performed. Eyes treated with PGAs were photoraphed and independently evaluated for PAP by 2 glaucoma specialists using at least 4 out of 7 clinical appearances. The factors of interest were sex, age, body mass index (BMI), types of glaucoma, types of PGAs, duration of PGA use, and concurrent 0.5% timolol. Univariate (χ2 test) and multivariate (multiple logistic regression) analyses assessing risk factors for PAP were performed to estimate the odds ratios (OR) with 95% conidence intervals (CIs).

RESULTS

One hundred thirty-four eyes from 134 patients were included. Seventy (52.2%), 21 (15.7%), and 43 (32%) eyes received components of latanoprost, travoprost, and bimatoprost, respectively. Prevalence of PAP was 44.8% (95% CI, 36.3 to 53.3). Older age >60 years (OR, 3.0; 95% CI, 1.2 to 7.8), bimatoprost (OR, 4.0; 95% CI, 1.6 to 9.5), travoprost (OR, 3.3; 95% CI, 1.1 to 10.1), and timolol (OR, 2.9; 95% CI, 1.3 to 6.8) were at risk of PAP development. In addition, BMI ≥23 kg/㎡ (OR, 0.3; 95% CI, 0.1 to 0.7) was reversely associated with PAP.

CONCLUSIONS

Older age, bimatoprost, or travoprost were associated with PAP, whereas high BMI was found as a protective factor. Interestingly, timolol possibly precipitated periorbital change when in use with prostaglandins.

[Prostaglandin analogues in glaucoma treatment]

AIM

to evaluate the effectiveness of prolatan (latanoprost 0.005%) in the treatment of primary open-angle glaucoma (POAG).

MATERIAL AND METHODS

The study included 35 POAG patients (41 eyes) aged 55-72 years, of them 20 men and 15 women. The patients were randomized into two groups followed up for 3 months. Group 1 consisted of 17 patients (19 eyes) who received prolatan once daily in the evening. Group 2 consisted of 18 patients (22 eyes) under Xalatan 0.005% once daily in the evening.

RESULTS

The true intraocular pressure (IOP) decreased by the average of 28.6%. Analysis of perimetry results showed a statistically reliable increase in the MD - by 17.4% in the study group and by 20% in the control group, and PSD indices - by 10.7% and 11.9%, respectively. Optical coherence tomography revealed an improvement of optic disc parameters in both groups. In particular, the cup volume decreased reliably by 8.4% and 6.3% and cup area - by 24.4% and 28.5%, respectively, while the rim area increased by 20.8% and 17.9%, respectively. The patients complained of neither burning, nor discomfort, nor foreign body sensation after prolatan instillations. We also report the absence of side effects.

CONCLUSION

The study has proved high antihypertensive effectiveness of prolatan. Improved morphometric parameters of the optic disc (decreased cup volume and area, increased rim area) indirectly indicate the neuroprotective potential of the drug. Being well-tolerated by the patients, prolatan can be recommended as the first choice treatment of glaucoma.

Prostanoids in patients with peripheral arterial disease: A meta-analysis of placebo-controlled randomized clinical trials

AIMS

Prostanoids are indicated in the treatment of peripheral arterial disease (PAD). Available trials suggest that these compounds could reduce the symptoms of intermittent claudication, even though the quality of studies is poor. The present meta-analysis is aimed at verifying the effects of prostanoids on amputation rate and ulcer healing in patients with lower limb PAD.

MATERIALS AND METHODS

The review protocol was published on http://www.crd.york.ac.uk/prospero (CRD42015020258). A comprehensive search for published and unpublished trials comparing iloprost, alprostadil, prostaglandin-E1, epoprostenol, or taprostene with placebo/no therapy on amputation rate in patients with PAD and ulcer healing rate in patients with concomitant foot ulcers. Mantel-Haenzel odds ratio (MH-OR) was calculated with random effect models for the chosen endpoints.

RESULTS

A total of 18 trials, enrolling 3,077 and 2,763 patients in the prostanoid and comparator groups, respectively were included in the analysis. Only 11 and 10 of those trials reported data on total and major amputations, respectively. Prostanoids were associated with a significantly lower risk of major (MH-OR [95% confidence interval] was 0.77 [0.63; 0.93], p=0.007), but not total, amputations. Healing rate (available only in 7 trials) was not significantly augmented by prostanoid treatment.

CONCLUSIONS

Available data are not sufficient to support an extensive use of prostanoids in patients with critical limb ischemia, as an adjunct to revascularization or as an alternative to major amputation in cases which cannot undergo revascularization.

A cross-sectional survey of the association between bilateral topical prostaglandin analogue use and ocular adnexal features

We studied the relation between prostaglandin analogue use and ocular adnexal features. We used a prospective, cross-sectional study involving 157 current, 15 past, and 171 never users of prostaglandin analogues. Patients 50 years of age or older and without conditions affecting ocular adnexal anatomy underwent glaucoma medication use history, external digital photography and systematic external adnexal exam. Two masked readers assessed the digital photos for upper lid dermatochalasis and lower lid steatoblepharon using a validated grading scheme. Another masked clinical examiner also assessed upper lid ptosis, levator muscle function, and inferior scleral show. We performed ordinal logistic regression analysis accounting for multiple covariates to assess the relation between prostaglandin analogue use and adnexal features. Multivariable analyses indicated there was a 230-fold increased risk of incremental involution of dermatochalasis (odds ratio (OR)  =  2.30; 95% confidence interval (CI) 1.43–3.69; p = 5.44E-04) and a 249-fold increased risk of incremental loss of lower lid steatoblepharon (OR  =  2.49; 95% CI, 1.54–4.03; p =  1.98E-04) associated with current prostaglandin analogue use (bimatoprost 0.03%, travoprost 0.005%, or latanoprost 0.004%) versus prostaglandin analogue never or past users. Upper lid ptosis (OR  =  4.04; 95% CI, 2.43–6.72; p = 7.37E-08), levator dysfunction (OR =  7.51; 95% CI, 3.39–16.65; p = 6.74E-07) and lower lid retraction (OR = 2.60; 95% CI, 1.58–4.28; p = 1.72E-04) were highly associated with current prostaglandin analogue use versus prostaglandin analogue never or past users. The associations between prostaglandin analogue use and deepening of the upper lid sulci and between prostaglandin analogue use and loss of inferior periorbital fat are confirmed in this multivariable analysis. The associations between prostaglandin analogue use and levator muscle dysfunction and between prostaglandin analogue use and upper lid ptosis represent significant side effects that could impact visual function in glaucoma patients.

[Efficacy and tolerability of preservative-free tafluprost 0.0015 % in the treatment of glaucoma and ocular hypertension]

AIM

The aim of the study was to evaluate the efficacy, safety and local tolerability of preservative-free tafluprost 0.0015% (Taflotan®) in patients with glaucoma and ocular hypertension.

MATERIALS AND METHODS

Multicentric, prospective observation study was performed in the Czech Republic from October 2010 to April 2011. A total of 78 centers participated and 754 patients were included. After the doctors decision to start the treatment with Taflotan®, the patients demographic data, previous treatment, intraocular pressure and the reason for switching the medication were recorded. At the follow-up visit after 6-12 weeks, the intraocular pressure, local tolerability (a 5-level scale), the patients and doctors satisfaction (a 4-level scale), and the patients preference were recorded.

RESULTS

Altogether, data of 496 patients were evaluated. The majority of them were women (64.9 %). The patients mean age was 58.5 years. The most common diagnosis was primary open angle glaucoma (79.2 %), followed by ocular hypertension (7.3 %), normal tension glaucoma (4.2 %), and pseudoexfoliation glaucoma (3.6 %). In 140 patients, tafluprost 0.0015% was the first antiglaucomatous medication started, 261 patients switched from another monotherapy, and 95 patients were treated with fixed- or nonfixed combinations before starting tafluprost 0.0015%. The most common reason for switching to Taflotan® was local intolerability to the current antiglaucomatous therapy (most often irritation of the eye and hyperemia). The intraocular pressure decreased significantly from 19.9 ± 4.5 mm Hg to 16.3 ± 3.0 mm Hg (p < 0.001). The subjective tolerability of the antiglaucomatous therapy improved rapidly, with 57.4 % of patients rating the tolerability of Taflotan® as "very good" and 34.5 % as "good". In addition, 94.4 % of patients and 96.0 % of ophthalmologists were "very satisfied" or "satisfied" with the treatment. At the final visit, 79.8 % of patients preferred Taflotan® to the previous treatment.

CONCLUSION

Taflotan® significantly decreased the intraocular pressure. It was well tolerated even in patients with previous intolerability to another antiglaucomatous therapy, including prostaglandins. The patients and ophthalmologists satisfaction with Taflotan® was high.

The effect of prostaglandin analogues on central corneal thickness of patients with chronic open-angle glaucoma: a 2-year study on 129 eyes

PURPOSE

To evaluate the effect of prostaglandin analogues on the central corneal thickness (CCT) of patients with chronic open-angle glaucoma (COAG).

METHODS

One hundred and twenty-nine eyes were included in this study. Of these, 108 were treated with prostaglandin analogues (latanoprost, travoprost and bimatoprost), while 21 eyes treated with β-blockers were used as controls. CCT was measured before treatment and at 3-month intervals.

RESULTS

A slight but significant increase in CCT was recorded in the bimatoprost and latanoprost groups. Treatment with bimatoprost produced a constant increase (1.85-8.83 μm) in CCT at all time-points of the study. The CCT rise found in the latanoprost group was significant for the first year. Treatment with travoprost did not affect CCT.

CONCLUSION

The possibility of corneal thickening under prolonged, local prostaglandin treatment should be investigated further. However, in clinical practice, CCT changes may sometimes influence intraocular pressure measurements significantly.

Herpetic keratitis in a patient who used two different prostaglandin analogue ophthalmic solutions: a case report

PURPOSE

To report a patient with glaucoma who developed recurrent herpetic keratitis while using two different prostaglandin analogue ophthalmic solutions.

RESULTS

A 72 year-old male patient with primary open angle glaucoma and a history of herpetic keratitis in the left eye experienced recurrent herpetic keratitis in the left eye after treatment with latanoprost ophthalmic solution. Herpetic flares were controlled after discontinuation of latanoprost. Adding travoprost ophthalmic solution 0.004% to his glaucoma therapy was also associated with a recurrence of herpetic keratitis.

CONCLUSION

To our knowledge, this is the first case in which travoprost has been associated to recurrent herpetic keratitis. Further, this is the first report in which a patient has a recurrence of herpetic keratitis associated to two different prostaglandin analogues. These findings suggest that patients with recurrent herpetic keratitis associated to a prostaglandin analogue might be predisposed to a flare-up with other prostaglandin analogues.

[Retina and glaucoma: therapeutic considerations]

This review describes the possible interactions between several retinal diseases, their treatment, and intraocular pressure (IOP). The use of the intravitreal route in the delivery of drugs to the retina has recently gained widespread acceptance with the development of the VEGF inhibitors and glucocorticoids such as triamcinolone. Although the intravitreal route offers high local concentrations in the vitreous, in the retina these advantages are offset by side effects, particularly short-term and chronic elevation of IOP. This review describes the clinical features of steroid glaucoma induced by triamcinolone or sustained-release systems of glucocorticoid drugs. Another aspect of the relationships between glaucoma and retina is also described: published reports of the occurrence of cystoid macular edema (CME) in eyes being treated with the prostaglandin analogs (PGAs) have led to concern regarding a possible causal relationship between the two. A review of the literature suggests that most PGA-treated eyes with CME had independent risk for development of CME, with a disruption of the blood-aqueous barrier: open or absent posterior capsule, history of dipivefrin-associated CME, epiretinal membrane, complicated cataract surgery, history of macular edema associated with branch retinal vein occlusion, ocular inflammation, and diabetes mellitus. In eyes at risk for CME, the use of PGAs is acceptable but must be prudent.

Intraocular pressure lowering effect of dorzolamide/timolol fixed combination in patients with glaucoma who were unresponsive to prostaglandin analogs/prostamides

OBJECTIVE

To evaluate the intraocular pressure lowering effect of the dorzolamide/timolol fixed combination (DTFC) in non-responder glaucoma patients to prostaglandin analogs/prostamides (prostas).

PATIENTS AND METHODS

All glaucoma patients treated with DTFC, between June 2003 and December 2005, who were unresponsive to prostaglandin analogs/prostamides, were identified through a retrospective medical records review. A non-responder was defined as an intraocular pressure (IOP) lowering effect less than 15% compared with baseline measurement. Two 12-hour IOP diurnal curves, measured between 8:00 a.m. and 8:00 p.m. (8:00 a.m., 10:00 a.m., 12:00 noon, 2:00 p.m., 4:00 p.m., 6:00 p.m. and 8:00 p.m.), were obtained retrospectively from the records of 31 patients, the first while on prostaglandin analogs/prostamides (baseline IOP) and the second while receiving DTFC (DTFC IOP). The study outcomes were the change in mean diurnal IOP and the reduction in IOP fluctuation as a result of receiving DTFC in patients unresponsive to prostas. The IOP was evaluated by intragroup comparisons with a two-tailed paired Student's t-test. A chi-square test was adopted for analysis of categorical variables.

RESULTS

31 patients were included in this retrospective study. DTFC significantly reduced IOP in the patients overall, from 25.4 (3.5) to 20.2 (1.0) mmHg, p < 0.0001. The majority of patients were diagnosed with pseudoexfoliative glaucoma (PEX) (58%; 18/31). DTFC reduced the mean IOP fluctuations over 12 hours (highest minus lowest IOP reading within the 12-hours pressure curve) from 8.6 (3.2) to 4.3 (1.4) mmHg, p < 0.0001. The most common adverse events were ocular burning (16%) and taste perversion (13%). There were no serious treatment-related adverse events.

CONCLUSION

DTFC significantly reduced the IOP in patients with glaucoma who did not respond to prostaglandin analogs/prostamides. Further research is needed to confirm these results.

The side effects of the prostaglandin analogues

In the last decade topically applied prostaglandin F2alpha analogues (bimatoprost, latanoprost, travoprost and unoprostone) have become widely used as a means to reduce elevated intraocular pressure in patients with glaucoma and ocular hypertension. These molecules all have similar side-effect profiles, which include both side effects that occur frequently (e.g., conjunctiva hyperaemia, increase of iris pigmentation and eyelash changes) and rare adverse reactions (e.g., periocular pigmentation, damage to the blood-aqueous barrier and cystoid macular oedema). Conjunctiva hyperaemia, eyelash changes and cystoid macular oedema are reversible, but certain other side effects, such as increased iris pigmentation, are not. However, the systemic side-effect profile is favourable for all the prostaglandin analogues, and some of the local side effects are only of cosmetic significance. Numerous clinical studies suggest that discontinuing treatment with prostaglandin analogues on account of their side effects is rare in clinical practice.

Association between topical prostaglandin analog use and development of choroidal neovascular membranes in patients with concurrent glaucoma and age-related macular degeneration

PURPOSE

Matrix metalloproteinases (MMPs) are a family of enzymes that act to degrade extracellular matrix (ECM) molecules, such as collagen, elastin, and gelatin. The glaucoma medication latanoprost, and possibly other topical prostaglandin analogs, increase uveoscleral outflow and lower intraocular pressure (IOP) in primary open-angle glaucoma (POAG) by activating MMPs 1, 2, 3, and 9 in the ciliary body. It has been reported that latanoprost may also gain access to the posterior segment and induce cystoid macular edema, although the mechanism is unknown. In the choroid, activation of some of the same subtypes of MMPs (particularly subtypes 2 and 9) has been implicated in the formation of choroidal neovascular membranes (CNVMs) in age-related macular degeneration (AMD). This study examined whether topical prostaglandin analog use is associated with a greater risk of CNVM formation in patients diagnosed with both AMD and POAG.

METHODS

A retrospective record review was performed to identify patients with a concurrent diagnosis of AMD and POAG between 1998 and 2004. Four hundred and eighty-four (484) eyes were identified and grouped as wet (n = 65) or dry (n = 419) AMD. Prostaglandin usage was compared between the two groups. Usage of other glaucoma medications was also compared. A minimum of 1 year of topical glaucoma medication was required for inclusion in the study. Exclusion criteria included a history of CNVM prior to starting glaucoma medications and a previous history of glaucoma surgery.

RESULTS

Fifty-six percent (56%) of dry AMD and 62% of wet AMD eyes were using a topical prostaglandin (P > 0.10; not significant). Analysis of specific topical prostaglandin analog usage in the wet versus dry AMD groups revealed no statistically significant differences in the percentage of eyes treated with latanoprost (37.7% versus 41.5%), bimatoprost (12.9% versus 10.8%), or travoprost (9.2% versus 5.3%), respectively. No significant differences in the use of other glaucoma medications were observed between the two groups.

CONCLUSIONS

No association between long-term topical prostaglandin use and CNVM development was found in patients with AMD and POAG.

Side effects of glaucoma medications

The safety profile of the different glaucoma medications is an important issue when initiating therapy in glaucomatous patients. The decision on which medication to prescribe depends not only on the type of glaucoma, but also on the patient's medical history and needs a detailed knowledge of the potential side-effects of each medication. Medications side effects may be an important cause of non adherence for the individual patient The properties of the drugs, the composition of the glaucoma eyedrops and the dynamics of ocular drug absorption must be considered. The ocular surface changes induced by long-term antiglaucomatous treatment especially by their preservatives are a major cause of intolerance or poor tolerance to glaucoma eyedrops. Moreover topically applied ophthalmic medications can attain sufficient serum levels through absorption into conjunctival and nasal mucosas to have systemic effects and to potentially interact with other drugs. Then this presentation will deal with the ocular and systemic side-effects which can be encountered with the different classes of the currently available glaucoma topical medications. Recommendations than can be applied to reduce both frequency and severity of side-effects of glaucoma medications will be stressed on. Concurrently patients should be fully informed not only about their disease but also the medications they used and what side-effects they have to expect.

Glaucoma Medications

As with many diseases, glaucoma increases in frequency in older populations, and is very often encountered in patients taking multiple medications. While the exact mechanism of glaucomatous optic neuropathy (GON) is not known, intraocular pressure (IOP) is thought to be central to the process, and reducing IOP is the only known effective treatment. The newer definition of glaucoma is an IOP-sensitive optic neuropathy. While large, controlled studies have indicated that reducing IOP will slow the progression of disease, the contributions of other conditions and medications have not been adequately studied. As the adverse effect profiles of medical therapies for glaucoma have improved, use of these agents has increased greatly. This has resulted in a large number of older patients taking glaucoma medications. Since topical medications can easily be overlooked in a medical history, and are for the most part well tolerated, systemic complications from these agents can be missed. In addition to being a common disease requiring treatment, glaucoma is also a model system for other degenerative diseases, and many of the concepts originally developed in relation to neurodegenerative diseases such as Alzheimer's disease are under investigation for glaucoma. These include approaches targeted towards neuroprotection and excitotoxicity.

Choroidal detachment after topical prostaglandin analogs: case report

OBJECTIVE

To report three cases of delayed choroidal detachment after treatment with topical prostaglandin analogs.

MATERIAL AND METHOD

Intervention three case reports. Four eyes of three patients with chronic angle closure glaucoma developed choroidal detachment after using topical prostaglandin analogs.

RESULTS

Three patients with chronic angle closure glaucoma developed chroidal detachment in one week, three weeks and two years after using travoprost, bimatoprost and latanoprost respectively. All of them resolved after discontinuation of these medications. All of the eyes that developed chroidal detachment were pseudophakic.

CONCLUSION

Travoprost, bimatoprost and latanoprost may lead to choroidal detachment and hypotony. Pseudophakic patients may be at high risk of the development of chroidal detachment. Topical prostaglandin analogs should be used cautiously in these patients.

Le traitement médical initial : bêtabloquants ou prostaglandines

In the initial treatment of glaucoma, prostaglandin analogs have indisputable advantages: better efficacy than timolol--particularly for inducing low or even very low IOP--but also their possible use in normotensive glaucoma, posology of a single instillation per day, and no systemic effects. The only disadvantages are minor local effects and a higher cost than beta-blockers.

Chirurgie de la cataracte et analogues des prostaglandines ?

Use of a prostaglandin analog in cataract surgery can cause cystoid macular edema in the pseudophakic patient, but this is a rare complication that resolves when treatment is stopped. However, in the surgical context, this type of eye drop should not be prescribed as first-line treatment and in any case it should be associated with nonsteroidal anti-inflammatory agents.

Studies on ocular inflammation and development of a prostaglandin analogue for glaucoma treatment

This review summarizes the Ernst H. Bárány Prize Lecture given at the meeting of the International Society of Eye Research in Geneva 2002. In the paper the path from the author's early studies on neurogenic inflammation in the eye to the search for a suitable prostaglandin analogue for glaucoma treatment, and the development of latanoprost are described. In particular the solution to the nociceptive and hyperemic side-effects of naturally occurring prostaglandins in the eye, the mechanism of action of FP prostanoid receptor agonists as well as the selection of dose for glaucoma treatment are discussed. In addition, pharmacokinetical aspects of latanoprost, and the melanogenic side-effect of prostaglandins in the iris are addressed. The paper is primarily focused on studies performed by the author and complete reference to other previous, or contemporary studies is therefore not always given as the purpose is not to present a comprehensive review article.

Prostaglandins for first-trimester termination

Since the 1980s, when mifepristone combined with a prostaglandin was found to be safe and effective for early abortion, many studies have refined the regimens and investigated alternatives such as methotrexate plus misoprostol, and misoprostol alone. Evidence now demonstrates that more than 200 mg of mifepristone provides no additional benefit, that vaginal misoprostol is superior to oral, especially between 7 and 9 weeks' gestation, and that misoprostol may be safely self-administered at home. Buccal and sublingual routes of administration of misoprostol also are promising. Absolute contraindications to medical abortion arise infrequently. Gastrointestinal and other side-effects occur in about one-third of women, primarily after administration of the prostaglandin. Careful assessment before and after medical abortion is essential and can be accomplished in various ways, depending on the skills of the clinician.

Prostaglandin postscript: a personal reflection

The long and arduous process that led to the development of ocular hypotensive prostaglandin derivatives over the past three decades has been reviewed several times. In this "postscript" to the second Survey of Ophthalmology supplement devoted to the ocular hypotensive effects of prostaglandin derivatives, only two aspects of this new approach to the medical management of glaucoma are discussed: 1) The implication of the observed prostaglandin-induced increase in iridial pigmentation with respect to the understanding of the role of prostaglandins and of iridial melanocytes in the protection against the damaging effects of light, and in the maintenance of normal intraocular microenvironment; and 2) The rationale behind the use of a combined formulation of a prostaglandin derivative and a beta-blocker for the protection against increased intraocular pressure. The need to consider not only target pressure, but also target mechanisms, in the selection of medical therapy regimen for any given glaucoma patient is emphasized.

Putative side effects of prostaglandin analogs

Anecdotal case reports describe the occurrence of cystoid macular edema, iritis, herpes simplex keratitis, periocular skin darkening, and headaches in patients treated with prostaglandin analogs for glaucoma. The purpose of this article is to critically analyze these anecdotal case reports in light of a few well-controlled, randomized clinical studies to determine whether conclusions can be made about a causal relationship between the use of prostaglandin analogs and the occurrence of these side effects. None of these putative side effects has been proven to be causally related to latanoprost therapy using valid scientific methodology. These possible side effects occur rarely. Cystoid macular edema, iritis, and herpes simplex keratitis occur in eyes with risk factors. To scientifically establish a causal relationship between drug therapy and rare side effects, repeated rechallenging with masked controls is required. With rare exception, such methodology has not been used with any of these putative side effects. Nevertheless, even without firm establishment of a causal relationship, caution is advised with the use of prostaglandin analogs in eyes with risk factors for cystoid macular edema, iritis, and herpes simplex keratitis until properly designed, large, controlled studies provide more definitive information.

New glaucoma medications in the geriatric population: efficacy and safety

Glaucoma can be considered a disease of the aging eye. Most medications used to treat glaucoma are in topical eyedrop form and may cause numerous untoward systemic effects in older persons. In recent years, several new ocular hypotensive medications have become available. These medications are being used more commonly because there is a growing trend by ophthalmologists to aggressively lower intraocular pressure. Therefore, geriatricians require a comprehensive knowledge of medications used to treat glaucoma, in addition to an understanding of their mechanism of action profiles of untoward effects and possible interactions with other diseases or medications. Therefore, we performed a review of the medications recently introduced into clinical practice. We selected drugs approved by the U.S. Food and Drug Administration between 1996 and September 2001. The safety profiles of these agents and their untoward side effects were reviewed by class: topical carbonic anhydrase inhibitors (brinzolamide: ocular tolerance, taste perversion), beta-adrenoceptor antagonists (timolol: bradycardia and bronchospasm), alpha-adrenergic agonists (brimonidine: oral dryness, headache, and fatigue), and prostaglandin analogs (latanoprost, bimatoprost, travoprost, and unoprostone isopropyl: ocular hyperemia, iris color changes). The function of this review is to make geriatricians more aware of the efficacy and untoward effects of medications recently introduced into clinical practice. We recommend that geriatricians perform a medication review on all medications their patients use, including eye drops.

Preparation of the cervix for surgical termination of pregnancy in the first trimester

Worldwide, surgical vacuum aspiration is the method of choice of terminating first trimester unwanted pregnancy. Cervical priming prior to surgical evacuation reduces the risks of cervical injury by making the cervix softer and easier to dilate. Over the years, a number of effective methods of cervical priming have became available: osmotic dilators; antiprogesterone and prostaglandins. Of these, prostaglandins remain the most widely used method of cervical preparation. However many of the natural and synthetic analogues of prostaglandins are either expensive or associated with troublesome side-effects. More recently, misoprostol, a synthetic 15-deoxy-16 hydroxy 16-methyl analogue of naturally occurring prostaglandin E, used in the management of peptic ulcers, has established a lead for cervical priming in terms of availability, ease of administration, cost and effectiveness. In fact it appears that both oral and vaginal misoprostol given at dosages of 400 microg are effective for cervical priming when administered 3 h prior to surgical vacuum aspiration. Now that the use of misoprostol for cervical priming has been validated, its widespread use in gynaecological practice is expected.

Pharmaceutical management of the childhood glaucomas

Glaucoma in childhood is a diverse, blinding group of conditions, which presents a major therapeutic challenge. Treatment is primarily surgical with medical treatments used as an adjunct. None of these drugs has been granted approval by the regulatory agencies for use in children, but they are used on a compassionate basis. Issues of efficacy and safety of these medications in children are discussed. beta-adrenoceptor blockers have been employed as first line pharmaceutical therapy for many years. Recently three new classes of drugs have been developed for use in glaucoma in adults. beta-blockers remain first line therapy if there are no contraindications such as asthma. Topical carbonic anhydrase inhibitors (CAI) appear to be less effective than beta-blockers, but seem safe systemically, although associated with local irritation. They are useful as an adjunct to beta-blockers or as first line therapy when beta-blockers are contraindicated. Prostaglandins have not proved as effective in childhood glaucoma as in adult glaucoma, although it works well in some patients with juvenile open angle glaucoma (JOAG) and others with aphakic glaucoma. alpha-adrenergic agonists, although effective at least in the short-term, have serious, potential systemic side effects, which demand close observation when used in neonates and young infants.

Pharmacologic management of peripheral vascular disease

Although our understanding of the pathophysiology of atherosclerosis and peripheral vascular disease continues to grow, we have yet to discover a medication that can safely and efficaciously be given to most claudicants that will alleviate their symptoms to prevent disease progression. Many patients with intermittent claudication improve or remain stable without therapy if they attempt to alter their risk factors (e.g., control of diabetes, smoking cessation, lowering of cholesterol levels). However, many require concomitant drug therapy to alleviate symptoms of PVD, and some require surgical intervention. Even with the recent advances in therapeutic development and the promise of agents currently in clinical trials, the questions of who to treat, when treatment should begin, and which agent to use remain uncertain.

[The use of prostaglandin compounds in treating glaucoma]

The theoretical part of this paper presents the mechanism of the IOP lowering effect using these drugs, the indications of treatment and the main side effects. The second part consist of the experimental study made on rabbits, using the izopropilic ester of (+)Cloprostenol as an hypotensive agent. We have registered the IOP values and the main side effect--conjunctival hyperemia. The third part consist of the clinical study, made on a test lot of 23 patients. We have used the same substance and in the experimental study, as a unique treatment or in association with a beta-blocker or a pilocarpine derivative. The following-up has implied: the IOP, the ophthalmoscopic appearance of the optic disc, the visual field, the visual acuity and the main side effects. In the end, we have formulated the conclusions of these studies.

Acute hemodynamic effects of the prostacyclin analog 15AU81 in severe congestive heart failure

This multicenter, open-label study provides the first assessment of the safety and acute hemodynamic effects of a short-term infusion of 15AU81, a chemically stable analog of prostacyclin, in patients with New York Heart Association class III or IV heart failure. Twelve patients underwent sequential dose escalation by increasing the rate of the infusion at 15-minute intervals until the drug was no longer tolerated. Patients then received a 90-minute infusion at their maximum tolerated dose. The infusion was then discontinued and the subjects were observed during a 90-minute washout segment. Serial hemodynamic measurements were made throughout the dose-ranging, maintenance, and washout segments. A significant decrease in systemic vascular resistance (1,935 +/- 774 vs 1,243 +/- 351 dynes.s.cm-5; p < 0.001) and pulmonary vascular resistance (395 +/- 335 vs 223 +/- 198 dynes.s.cm-5; p = 0.008) occurred from the infusion of vehicle to the maximum tolerated dose. During dose titration, there was a a significant increase in cardiac index (1.9 +/- 0.7 vs 2.6 +/- 0.6 liters/min/m2; p < 0.001) and a tendency for a mild reduction in pulmonary artery wedge pressure (18 +/- 7 vs 17 +/- 6; p = 0.055) for the 8 patients with values on vehicle and maximum tolerated dose. These hemodynamic changes persisted during the maintenance infusion and disappeared rapidly during the washout segment. The most common adverse event to limit dose-ranging was headache, which occurred at a mean maximum tolerated dose of 36 +/- 15 ng/kg/min. Administration of 15AU81 was associated with significant acute hemodynamic improvement in patients with severe heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of ciprostene on restenosis rate during therapeutic transluminal coronary angioplasty

Ciprostene, a chemically stable prostacyclin analog was studied for its effects on restenosis in patients with coronary artery disease undergoing therapeutic percutaneous transluminal coronary angioplasty (PTCA). In a double-blind, randomized trial 32 patients were randomized to receive either ciprostene or the respective placebo. The infusion started intracoronarily at a rate of 40 ng/kg/min 20 min before introduction of the balloon catheter into the coronary artery. Thereafter infusion was continued intravenously for 36 hours at a rate of 120 ng/kg/min and a tapering off period until 48 hours. The quantitative analyses of the degree of coronary artery stenoses on the angiographic films before PTCA, after PTCA and after 6 month of follow-up was performed in 24 patients available. In patients receiving placebo (n = 12) coronary artery stenoses was 81 +/- 3% before PTCA and was reduced to 34 +/- 3% by angioplasty. At the 6 month follow up angiography stenoses diameter was measured as 63 +/- 8%, being not significantly different from the % stenoses before PTCA. In contrast, coronary artery stenoses in patients receiving ciprostene (n = 12) measured 83 +/- 3% before PTCA, 31 +/- 4% after PTCA and 55 +/- 9% at 6 month, being still significantly different from pre-PTCA value (P less than 0.05). When patients were characterized according to their clinical status, these differences were accounted for by patients with unstable angina receiving ciprostene. Ciprostene seems to reduce restenosis 6 month after coronary angioplasty in patients with unstable angina. The infusion rate of 40 ng/kg/min i.c. followed by 120 ng/kg/min i.v. was tolerated well, although the incidence of catheter associated bleeding was increased.

RU486 combined with PG analogs in voluntary termination of pregnancy

This French study evaluates the clinical results of administering RU486 with prostaglandin analogs in early pregnancy. Since 1986, RU486 has been used with prostaglandin analogs to interrupt pregnancies of less than 49 days' amenorrhea. Success rate among 10,250 cases was 95.3%. Failures involve ending of pregnancy without expulsion (2.8%), and ongoing pregnancy (1.1%). Two cases of cardiovascular complications following administration of the prostaglandin have occurred. The majority of users prefer this method because it eliminates need for surgery and anesthesia, and it allows the patient to take an active role in the procedure.

Drug safety of rioprostil in patients with active gastric or duodenal ulcer

Data from a large number of patients (1918) treated with rioprostil, H2-antagonists and placebo, are analysed to examine the safety profile of rioprostil in the treatment of active gastric ulcer or active duodenal ulcer. Rioprostil is administered to 1000 of those patients. Patients who dropped out of the studies and those with adverse drug reactions are classified and compared within different subgroups. The overall dropout rate for rioprostil patients is 8.8%: 2.3% of these because of adverse reactions. The incidence of adverse reactions during rioprostil treatment is 20.9%, with more than 60% of these having gastrointestinal symptoms, mainly appearing in the first week of therapy. Comparisons show a higher incidence of symptoms with rioprostil treatment than with ranitidine treatment because of the gastrointestinal symptoms. Possible differences are found between groups in sex, age, and drug dose. The analysis of laboratory variables does not show clinically important changes as a result of rioprostil treatment.

Prostaglandins and the gastrointestinal mucosa: are they important in its function, disease, or treatment?

In 1971 interest in the role of prostaglandins in the gastrointestinal tract was stimulated by the publication of two hypotheses--that aspirin damaged the gastric mucosa by inhibiting prostaglandin synthesis (1) and that cholera toxin caused diarrhea by stimulating it (2). Subsequent research into the gastrointestinal actions of prostaglandins has been considerable and now impinges on clinical practice. This paper reviews the involvement of prostaglandins and related compounds in mucosal protection, in ulcer healing, in diarrhea, and in gastrointestinal inflammation, with particular reference to the growing body of human data.

[Cervix ripening and labor induction in therapeutic abortion in the middle and late 2d trimester using intracervical and extra-amniotic prostaglandin gel administration]

In 64 patients for therapeutic abortion between the 17th to 26th week of pregnancy abortion was induced with a standardized two-step procedure. After priming of the cervix with intracervical application of prostaglandin gel, labour was induced with extraamniotic PG-administration under epidural anaesthesia. The priming effect was demonstrated objectively in 10 patients with a mechanical tonometer. Prostaglandin F2 alpha, PGE2 and sulprostone were used in the study. There were no significant differences in the total length of therapy (cervix priming time plus induction of labour to abortion interval) between the three groups of patients. Except for 4 patients who required an instrumental extraction of the fetus, abortion occurred in all the patients within a total time of 30 hours (93.8%). The mean induction of labour to abortion interval was 8.3 hours (range: 1.0 to 17.3 hours) in all patients and there was, again, no significant difference between the three groups. Epidural anaesthesia gave a painless induction of abortion in 60 out of 62 patients, while 2 patients required additional analgesics. In 2 patients epidural anaesthesia was contraindicated. In contrast to the systemic administration of PG the incidence of gastrointestinal side effects was low (10.9%). In one case a cervical lesion was observed due to a tenaculum laceration. Although there was no general antibiotic prophylaxis endometritis occurred in only 3 cases (4.7%). The combination of intracervical PG gel for cervical priming, extraamniotic PG gel for labour induction and epidural anaesthesia presents a gentle and efficient method for the termination of pregnancy in the middle to late second trimester.

Prostaglandin treatment and subsequent cystic ovarian disease in Holstein cows

Using computerized herd health data, a prospective cohort study was devised to determine whether cows treated with prostaglandins had a higher incidence of cystic ovarian disease than comparable cows not treated. Of 744 cows selected as having diseases for which prostaglandin administration may be indicated, 240 received prostaglandin. Sixteen cows had cystic ovarian disease following prostaglandin administration. Chi-square analysis showed no association (P greater than 0.10) between cystic ovarian disease and the use of prostaglandin. Incidence of cystic ovarian disease within 150 days of calving in clinically normal cows was compared with that of cows with reproductive disorders. Cows with reproductive disorders had a significantly (P less than 0.01) higher incidence of cystic ovarian disease.