Purpose:To investigate the factors affecting the long-term efficacy of latanoprost in primary congenital glaucoma (PCG) and Childhood glaucoma (ChG). Methods:Patients with PCG or ChG treated with latanoprost 0.005% eyedrops were re-examined. At study visit and from clinical charts were evaluated: intraocular pressure, length of glaucoma control with latanoprost treatment, need of further medication or glaucoma surgery, systemic and topical side effects. A congenital glaucoma severity score was calculated by clinical parameters. Results:Forty-six eyes of 27 patients (35 with PCG; 11 with ChG) had been treated with latanoprost. Eleven eyes had received previous surgery. Mean follow-up was 91±47 months. Latanoprost therapy was successful over the long term in 18 eyes (39%), 6 eyes (13%) had required an additional therapy, 19 eyes (41%) had received surgery. For 3 PCG eyes (7%), latanoprost had been discontinued. In the eyes with successful glaucoma control by latanoprost, mean IOP reduction was 8.5±1.8 mmHg (35.6%). Factors allowing the prediction of the success of treatment (glaucoma control with latanoprost) were established through a decision tree induction (with Chi-Squared Automatic Interaction Detection -CHAID- segmentation technique). These are: glaucoma diagnosis at age greater than 4 months (success rate: 37% in eyes with glaucoma diagnosis at age lower/equal than 4 months, vs 63% in eyes with glaucoma diagnosis at age greater than 4 months,chi-square p=.004), and in this latter group, no previous glaucoma surgery (success rate: 48% in eyes without previous glaucoma surgery vs 15% in eyes with previous glaucoma surgery, chi-square p=0.029). The length of glaucoma control by latanoprost was related to the age at treatment (linear regression r=0.519, p<0.001), and, in children treated at age<1 year, to severity score (linear regression r= -0.522, p=0.015). The mean length of treatment was lower in PCG than in ChG eyes (38±40 and 78±47 months, t-test P=0.023). No patient discontinued the treatment because of side effects (in 4 eyes mild conjunctival hyperaemia; in 1 eye increase of iris pigmentation and eyelash changes, both regressed 3 years after discontinuation because of low IOP; in 1 patient irritation of the upper airways that regressed with systematic nasolacrimal occlusion on instillation of drops). Conclusions:Long-term treatment with latanoprost in primary congenital glaucoma is effective in about a third of the treated eyes; factors related to long-term success of the treatment were age at the diagnosis greater than 4 months, and no previous glaucoma surgery; the glaucoma control by latanoprost was longer in eyes with less severe glaucomatous alterations and in ChG.
Factors Affecting The Long-term Efficacy Of Latanoprost In Congenital Glaucoma
UVA, Maurizio Giacinto;LONGO, ANTONIO;REIBALDI, MICHELE;PULVIRENTI, ALFREDO;AVITABILE, Teresio;
2012-01-01
Abstract
Purpose:To investigate the factors affecting the long-term efficacy of latanoprost in primary congenital glaucoma (PCG) and Childhood glaucoma (ChG). Methods:Patients with PCG or ChG treated with latanoprost 0.005% eyedrops were re-examined. At study visit and from clinical charts were evaluated: intraocular pressure, length of glaucoma control with latanoprost treatment, need of further medication or glaucoma surgery, systemic and topical side effects. A congenital glaucoma severity score was calculated by clinical parameters. Results:Forty-six eyes of 27 patients (35 with PCG; 11 with ChG) had been treated with latanoprost. Eleven eyes had received previous surgery. Mean follow-up was 91±47 months. Latanoprost therapy was successful over the long term in 18 eyes (39%), 6 eyes (13%) had required an additional therapy, 19 eyes (41%) had received surgery. For 3 PCG eyes (7%), latanoprost had been discontinued. In the eyes with successful glaucoma control by latanoprost, mean IOP reduction was 8.5±1.8 mmHg (35.6%). Factors allowing the prediction of the success of treatment (glaucoma control with latanoprost) were established through a decision tree induction (with Chi-Squared Automatic Interaction Detection -CHAID- segmentation technique). These are: glaucoma diagnosis at age greater than 4 months (success rate: 37% in eyes with glaucoma diagnosis at age lower/equal than 4 months, vs 63% in eyes with glaucoma diagnosis at age greater than 4 months,chi-square p=.004), and in this latter group, no previous glaucoma surgery (success rate: 48% in eyes without previous glaucoma surgery vs 15% in eyes with previous glaucoma surgery, chi-square p=0.029). The length of glaucoma control by latanoprost was related to the age at treatment (linear regression r=0.519, p<0.001), and, in children treated at age<1 year, to severity score (linear regression r= -0.522, p=0.015). The mean length of treatment was lower in PCG than in ChG eyes (38±40 and 78±47 months, t-test P=0.023). No patient discontinued the treatment because of side effects (in 4 eyes mild conjunctival hyperaemia; in 1 eye increase of iris pigmentation and eyelash changes, both regressed 3 years after discontinuation because of low IOP; in 1 patient irritation of the upper airways that regressed with systematic nasolacrimal occlusion on instillation of drops). Conclusions:Long-term treatment with latanoprost in primary congenital glaucoma is effective in about a third of the treated eyes; factors related to long-term success of the treatment were age at the diagnosis greater than 4 months, and no previous glaucoma surgery; the glaucoma control by latanoprost was longer in eyes with less severe glaucomatous alterations and in ChG.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
