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A 6-Month Randomized Trial

Enyr S. Arcieri, MD; Alessandro Santana, MD; Fabiano N. Rocha, MD; Gustavo L. Guapo, MD; Vital P. Costa, MD

Arch Ophthalmol. 2005;123:186-192.

Objectives  To investigate the effects of prostaglandin analogues on the blood-aqueous barrier and to evaluate the occurrence of cystoid macular edema in aphakic or pseudophakic patients with glaucoma.

Methods  In this randomized, masked-observer, 6-month clinical trial, patients with primary open-angle, pseudophakic, or aphakic glaucoma were treated once daily with bimatoprost (n = 16), latanoprost (n = 15), or travoprost (n = 17) or twice daily with unoprostone (n = 16) or lubricant drops (control group) (n = 16). Blood-aqueous barrier status, which was assessed using a laser flare meter; intraocular pressure; the occurrence of angiographic cystoid macular edema; and conjunctival hyperemia were evaluated.

Results  Mean flare values were significantly higher in the bimatoprost, latanoprost, and travoprost groups throughout follow-up (P < .02). Four latanoprost-treated eyes, 1 bimatoprost-treated eye, and 1 travoprost-treated eye developed cystoid macular edema; all cases resolved after discontinuation of the prostaglandin analogue and treatment with topical diclofenac sodium. Mean intraocular pressure reductions after 6 months were higher for the latanoprost (26%), bimatoprost (28%), and travoprost (29%) groups than for the control (3%) and unoprostone (14%) groups (P< .05). Bimatoprost induced significantly higher hyperemia scores than latanoprost, unoprostone, and placebo (P< .01).

Conclusion  Bimatoprost, latanoprost, and travoprost use may lead to disruption of the blood-aqueous barrier in patients with pseudophakia and aphakia.

Author Affiliations: Glaucoma Service, Department of Ophthalmology, University of Campinas, Campinas, São Paulo, Brazil (Drs Arcieri, Santana, Rocha, and Guapo); Department of Ophthalmology, School of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil (Dr Arcieri); and Department of Ophthalmology, University of São Paulo (Dr Costa).