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M.G. Uva, A. Longo, V. Cannemi, A. Reibaldi; Efficacy and Safety of Latanoprost in Congenital Glaucoma . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2163.
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Purpose: Congenital glaucoma is a rare and polimorphous condition whose treatment is primarily surgical. None of ocular hypotensive drugs has been granted approval by the regulatory agencies for use in children, but they are all used on a compassionate basis. To the best of our knowledge in literature there are only four publications about the pediatric use of prostaglandin analogs. According with the results of these studies latanoprost does not seem as effective in pediatric glaucoma patients as in adults with POAG or ocular hypertension. We wish to report our experience with latanoprost in the treatment of congenital glaucoma. Methods: In a retrospective way, we analyzed the charts of all patients with congenital glaucoma who were given latanoprost at our Institution between January 1997 and July 2002. We excluded from the analysis patients with uncertain or inadequate baseline IOP measurements or who had follow up less than 2 months or underwent surgery within 6 months before of starting latanoprost. The baseline IOP was compared with the final one (at the end of follow up) for each patient and any side effect was reported. Results: 22 eyes of 14 patients with diagnosis of congenital glaucoma were included in this study. The mean follow up was 12.7±14.5 months (range 2-60). The baseline mean IOP was 25.7±3.4 mmHg, the final mean IOP was 18.6±8.1 mmHg with an average IOP decrement of 7.1±7.2 mmHg (28.3%). Five eyes (22.7%) of 5 patients had no useful change in IOP and underwent surgery, being considered as failure and excluded from subsequent analysis.Three eyes of 2 patients showed a lasting decrement of IOP even after stopping the treatment with latanoprost (respectively administered for 12 and 16 months). In one of these patients, affected with unilateral congenital glaucoma iris color change and increased eyelash thickness occurred after 10 months of therapy, then latanoprost treatment was discontinued 6 months later, owing to a lasting IOP in the low teens. After a subsequent 36 months follow up time with no therapy, IOP lasted in the low teens and iris pigmentation reversed. Conclusions: Unlike other authors' experience, e.g. the Enyedi et al. study (J.AAPOS 3:33-9,1999), involving children with a wide variety of glaucoma diagnoses and showing little IOP effect from this drug, in our study, involving exclusively a case series of congenital glaucomas, latanoprost showed an impressive ocular hypotensive effect and appeared to be well tolerated in pediatric patients. In our opinion, the observation of three cases of IOP lowering that lasted after stopping the treatment and the observation of reversal of iris pigmentation are very intriguing even if yet anecdotal.
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