Abstract
Purpose :
To report a possible usefulness of a novel grading for prostaglandin-associated periorbitopathy (PAP) which we referred to the Shimane University PAP Grading System (SU-PAP), distribution of PAP severity among subjects using a topical FP or EP2 receptor agonist was assessed.
Methods :
Consecutive 460 Japanese subjects (211 men; mean age ± SD, 69.9±14.5 years) who had used either a FP agonist (latanoprost, tafluprost, travoprost, bimatoprost, or fixed combinations of these) or EP2-agonist (omidenepag) for >3 months in at least one eye were retrospectively included. Age, sex, prostaglandin, intraocular pressure (IOP) measured by Goldmann applanation tonometry (IOPGAT) and iCare rebound tonometry (IOPRBT), difference between IOPGAT and IOPRBT (IOPGAT-RBT), and PAP grade were were collected. Clinical parameters were compared among groups stratified by SU-PAP grades; SU-PAP grades were descried and compared among groups stratified by prostaglandins.
Results :
Of the study subjects, 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 mmHg) than grades 0 (15.0±5.1 mmHg, P=0.0324) and 1 (14.5±4.2 mmHg, P=0.0076), and the IOPGAT-RBT was significantly higher in grade 3 (5.8±3.2 mmHg) than the other three grades (1.3-1.9 mmHg, P<0.0001 for all comparisons); the IOPRBT was equivalent among the four 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<0.0001 for both comparisons) and tafluprost (1.0±0.7, P<0.0001 for both comparisons), but significantly lower associated with omidenepag (0.0±0.0, P<0.0001 for all comparisons) than the other four 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.
Conclusions :
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.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.