The Effect of Latanoprostene Bunod on Nailfold Capillary Blood Flow in Patients with Primary Open-Angle Glaucoma.

Abstract

Purpose : To compare nailfold capillary blood flow changes on the nailfold beds of patients with primary open-angle glaucoma after application of either latanoprostene bunod, latanoprost, or balanced saline solution.

Methods : This is a randomized, prospective study. Patients diagnosed with POAG between the ages of 18-80 years who visited glaucoma practices at the New York Eye and Ear Infirmary of Mount Sinai were included. Patients were randomly assigned to one of three intervention groups: latanoprostene bunod 0.024% (LTB), latanoprost 0.005% (Lat), or balanced saline solution 0.9% (BSS). Two nailfold capillaroscopy (NFC) recordings of the 4^th finger of the non-dominant hand were collected: a baseline video, followed by a post-intervention recording after applying the randomized solution for 12 minutes. Blood flow measurements were calculated by a blinded operator. For each recording, nine capillaries were measured and averaged. A ratio of post- to pre-intervention blood flow was calculated for each patient (post-intervention flow/baseline flow). All analysis was done on GraphPad software and statistical significance was calculated using the student paired t-test (p<0.05).

Results : 31 patients were included. 9 received BSS, 8 received Lat, and 14 received LTB. The average age was 66.39 years. Age, sex, smoking history, current anti-platelet or anti-coagulant use, and presence of hypertension, diabetes mellitus, or connective tissue disorders were similar between the groups (p>0.05). The mean ratio for blood flow response was 0.85 ± 0.24 for saline, 0.95 ± 0.36 for latanoprost, and 1.37 ± 0.51 for LTB. The blood flow responses between BSS and Lat (p = 0.545) and between Lat and LTB (p = 0.055) were similar. Blood flow ratio significantly improved after the application of LTB compared to BSS (p = 0.015).

Conclusions : The mean nailfold blood flow was decreased after the application of saline, nearly unchanged with latanaprost and improved with latanoprostene bunod. The organonitrate moiety of latanoprostene bunod may in part be responsible for improving nailfold blood flow. A larger sample size and adjustment for confounders could serve to further elucidate the blood flow responses to glaucoma medications.

This is a 2020 ARVO Annual Meeting abstract.