Intraocular pressure-lowering effects of latanoprost monotherapy versus latanoprost or pilocarpine in combination with timolol: a randomized, observer-masked multicenter study in patients with open-angle glaucoma. Italian Latanoprost Study Group

J Glaucoma. 1999 Feb;8(1):24-30.


Purpose: To compare intraocular pressure (IOP) after adding either latanoprost or pilocarpine to timolol treatment or switching to latanoprost monotherapy in glaucomatous eyes in which IOP was inadequately controlled with timolol.

Methods: This 6-month randomized study comprised 148 patients with primary open-angle or pseudoexfoliation glaucoma, which was inadequately controlled with topical beta-adrenergic antagonists. After a 2- to 4-week run-in period with timolol 0.5% twice daily, patients were assigned in randomized fashion to three study groups: one group received add-on therapy of latanoprost 0.005% once daily, the second group received add-on therapy of pilocarpine 2% three times daily, and the third group switched to latanoprost 0.005% once daily. Mean diurnal IOP was measured at baseline and after 3 and 6 months of treatment.

Results: At 6 months, 128 patients had completed the study. Diurnal IOP was significantly reduced from baseline in all groups. Adding latanoprost to timolol treatment reduced diurnal IOP by 6.1+/-0.3 mmHg (-28%), adding pilocarpine to timolol treatment reduced diurnal IOP by 4.2+/-0.3 mmHg (-19%), and switching from timolol to latanoprost monotherapy reduced diurnal IOP by 5.5+/-0.3 mmHg (-25%).

Conclusion: A significantly greater reduction in diurnal IOP was achieved after addition of latanoprost than after addition of pilocarpine in patients in whom IOP was not adequately controlled with timolol alone. Further, the results of this study indicate that a switch to latanoprost monotherapy can be attempted before combination treatment is initiated.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / therapeutic use*
  • Adult
  • Aged
  • Circadian Rhythm
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Glaucoma, Open-Angle / drug therapy*
  • Glaucoma, Open-Angle / physiopathology
  • Humans
  • Intraocular Pressure / drug effects*
  • Intraocular Pressure / physiology
  • Latanoprost
  • Male
  • Middle Aged
  • Miotics / administration & dosage
  • Miotics / therapeutic use*
  • Ophthalmic Solutions
  • Pilocarpine / administration & dosage
  • Pilocarpine / therapeutic use*
  • Prostaglandins F, Synthetic / administration & dosage
  • Prostaglandins F, Synthetic / therapeutic use*
  • Single-Blind Method
  • Timolol / administration & dosage
  • Timolol / therapeutic use*
  • Treatment Outcome


  • Adrenergic beta-Antagonists
  • Miotics
  • Ophthalmic Solutions
  • Prostaglandins F, Synthetic
  • Pilocarpine
  • Latanoprost
  • Timolol