Changes in intraocular pressure and ocular perfusion pressure after latanoprost 0.005% or brimonidine tartrate 0.2% in normal-tension glaucoma patients

Ophthalmology. 2002 Dec;109(12):2241-7. doi: 10.1016/s0161-6420(02)01247-2.

Abstract

Objective: To evaluate and compare the effects of latanoprost 0.005% once daily and brimonidine tartrate 0.2% twice daily in patients with normal-tension glaucoma (NTG).

Design: A randomized, open-label, crossover study.

Participants: Twenty-eight NTG patients with progressive visual field defects/optic disc excavation, new disc hemorrhage, or field defects that threatened fixation.

Intervention: Patients were randomly allocated to one of two groups. Patients in group 1 were treated with latanoprost, lubricant, and brimonidine for 4 weeks each, whereas patients in group 2 were treated with brimonidine, lubricant, and latanoprost for 4 weeks each.

Main outcome measures: Intraocular pressure (IOP), pulse rate, and blood pressure were measured at 8 am, 12 noon, and 4 pm after each 4-week treatment. Ocular perfusion pressure (OPP) was calculated.

Results: Latanoprost and brimonidine reduced the average IOP by 3.6 +/- 1.9 mmHg (P < 0.001) and 2.5 +/- 1.3 mmHg (P < 0.001), respectively, with a significant difference between the two regimens (P = 0.009). Both drugs significantly reduced IOP at each time point. Latanoprost decreased IOP significantly more than did brimonidine at 8 am (11.7 +/- 2.2 mmHg vs. 13.7 +/- 2.1 mmHg, P = 0.004) and 4 pm (11.4 +/- 2.1 mmHg vs. 13.2 +/- 2.9 mmHg, P = 0.004), but IOP was equal between the two agents at 12 noon (11.5 +/- 2.6 mmHg vs. 11.5 +/- 2.3 mmHg, P = 0.967). IOP was maintained at 12 mmHg or lower in 18 (66.7%) of 27 patients after treatment with latanoprost and in 9 (33.3%) of 27 patients after treatment with brimonidine. Latanoprost monotherapy reduced IOP by 30% in 8 patients (29.6%), but brimonidine monotherapy did not reduce IOP by that much in any of the patients. OPP increased after latanoprost treatment (P < 0.001) but did not increase after brimonidine treatment (P = 0.355). There was no significant change in pulse rate or blood pressure.

Conclusions: Both latanoprost and brimonidine reduce IOP in NTG patients. Brimonidine has a peak IOP-lowering effect equal to that of latanoprost but produces a higher mean diurnal IOP than does latanoprost because of its shorter effect. Latanoprost might favorably alter optic disc blood perfusion by increasing OPP.

Publication types

  • Clinical Trial
  • Comparative Study
  • Evaluation Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic alpha-Agonists / administration & dosage
  • Adrenergic alpha-Agonists / therapeutic use*
  • Adult
  • Aged
  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects
  • Brimonidine Tartrate
  • Cross-Over Studies
  • Drug Evaluation
  • Eye / blood supply*
  • Female
  • Glaucoma, Open-Angle / drug therapy*
  • Glaucoma, Open-Angle / physiopathology
  • Heart Rate / drug effects
  • Humans
  • Intraocular Pressure / drug effects*
  • Latanoprost
  • Male
  • Middle Aged
  • Optic Disk / drug effects
  • Optic Disk / physiopathology
  • Optic Nerve Diseases / drug therapy
  • Optic Nerve Diseases / physiopathology
  • Prostaglandins F, Synthetic / administration & dosage
  • Prostaglandins F, Synthetic / therapeutic use*
  • Quinoxalines / administration & dosage
  • Quinoxalines / therapeutic use*
  • Vision Disorders / drug therapy
  • Vision Disorders / physiopathology
  • Visual Fields / drug effects

Substances

  • Adrenergic alpha-Agonists
  • Antihypertensive Agents
  • Prostaglandins F, Synthetic
  • Quinoxalines
  • Brimonidine Tartrate
  • Latanoprost