Latanoprost with adjunctive m1otic therapy in a compassionate case protocol

Purpose. To evaluate the ocular hypotensive response of latanoprost 0.005% administered as adjunclive therapy in patients with glaucoma receiving adjunctive miotic therapy in a compassionate case protocol. Methods. 160 consecutive patients entering a latanoprost compassionate clinical trial were enrolled at two sites. Latanoprost was administered as a single drop between 6:00 and 8:00 P.M. and all other medications were continued. 81 patients were treated with various concentrations of pilocarpine, carbachol, or echothiophate iodide (PI) prior to latanoprost administration. Miotics were independently categorized by pharmacologie agent and relative strength (weak, moderate, strong). IOP was measured between 2:00 and 4:00 P.M. Results. At one month, patients treated with pilocarpine (n=53) responded better to the addition of latanoprost when compared to eyes receiving carbachol or PI (n=16) (mean IOP reduction 5.1 ± 4.6 vs 1.7 ±4.4 mmHg (p=0.01). Eyes receiving weaker miotics (n=16, mean IOP decrease 5.6 i 4.6 mmHg) tended to have a greater reduction in IOP than both moderate (n-45, 4.0 ±4.9 mmHg) and strong miotics (n=8, 3.4 ±4.4 mmHg), although these differences were not statistically significant. Upon cessation of miotic therapy, approximately equal numbers of patients had IOP reduction and elevation. Conclusion. Patients on stronger miotics respond less well to the addition of latanoprosl than do patients on weaker agents or concentrations. Supported m part by the New York Glaucoma Research Institute, the Kosciuszko Foundation, NY (Dr. Patelska), and the Department of Ophthalmology Research Fund of the New York Eye and Ear Infirmary. None.