Abstract
Purpose :
Latanoprostene bunod (LBN) is a nitric oxide donating prostaglandin analog recently approved for intraocular pressure (IOP) reduction. The purpose of this study was to evaluate the effectiveness of LBN in patients with advanced glaucoma.
Methods :
The study was a retrospective chart review of electronic health records at the University of Michigan, which was approved under an IRBMED protocol. Study criteria included use of LBN and availability of IOP measurements prior to and after starting LBN. Clinical and demographic data extracted included age, sex, race, cup-to-disc ratio, central corneal thickness (CCT), use of topical glaucoma and systemic medications, cornea hysteresis (CH), prior eye surgeries and prior laser trabeculoplasty. If LBN was used in both eyes, the eye with higher IOP prior to starting LBN was considered the study eye. Paired t-test was used to compare IOPs prior to and after starting LBN. Regression models using generalized estimating equations were used to examine the association of clinical and demographic factors on IOP change.
Results :
53 patients, 24 male and 29 female, met study criteria. 18 of these used LBN in one eye and 35 used LBN in both eyes. The eyes had the following glaucoma severity ratings: 14 eyes mild, 2 eyes mild-moderate, 14 eyes moderate, 51 eyes severe, and 7 eyes were not reported. The mean ± standard deviation (SD) age was 62 ± 18 years, ranging from 14 to 87 years. Treated eyes had a mean ± SD of 3.2 ± 1.3 medications used for glaucoma management and 2.5 ± 2.05 ocular surgeries. On average IOP in the study eye decreased by 0.67 mmHg after starting LBN [Mean ± SD = 0.67 ± 3.76; P = 0.21]. Factors affecting IOP change after LBN use were CCT, CH and use of topical carbonic anhydrase inhibitors (CAI). 1 µm increase in CCT was associated with 0.03 mmHg increase in IOP after LBN use (β = -0.03; 95% CI [-0.04, -0.01], P = 0.005). 1 mmHg increase in CH was associated with a 0.32 mmHg increase in IOP after LBN use (β = -0.32; 95% CI [-0.62, -0.01], P = 0.04). Additionally, participants who used topical CAI had 1.38 mmHg decrease in IOP after LBN use, compared to those who did not use topical CAI (β = 1.38; 95% CI [-0.13, 2.88], P = 0.07).
Conclusions :
LBN use in patients with moderate to advanced glaucoma did not result in a significant IOP response. Thicker CCT and higher CH were associated with lesser response to LBN. Concurrent use of topical CAI was associated with a greater IOP response to LBN.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.