Twenty-four hour intraocular pressure reduction with latanoprost compared with pilocarpine third-line therapy in exfoliation glaucoma

Purpose To compare the 24 hour efficacy of latanoprost 0.005% given every e vening with that of pilocarpine 4% given four times daily as third-line the rapy in patients with exfoliation glaucoma receiving timolol 0.5% and dorzo lamide 2% each given twice daily. Method We enrolled 30 patients with exfoliation glaucoma not adequately con trolled on timolol maleate 0.5% and dorzolamide 2%. Each patient underwent a baseline 24 hour intraocular pressure curve testing at 06:00, 10:00, 14:0 0, 18:00, 22:00 and 02:00 hours. Patients were randomised to receive either latanoprost 0.005% or pilocarpine 4% for a minimum of 8 weeks and were the n crossed over to the opposite therapy. Diurnal curve testing was repeated at the end of each treatment. Results There was a significant decrease from baseline in intraocular press ure at each timepoint for both study medicines (p < 0.016). Latanoprost pro vided better intraocular pressure control than pilocarpine at daytime measu resments (17.4 vs 19.7 mmHg at 06:00 hours, p < 0.001; 17.8 vs 19.1 mmHg at 10:00 hours, p = 0.04). However, pilocarpine reduced the pressure more tha n latanoprost at 22:00 hours (18.4 vs 19.5 mmHg, p = 0.016). Overall, the d iurnal intraocular pressure was reduced from a baseline of 21.5 +/- 3.7 mmH g to 18.8 +/- 3.1 mmHg on pilocarpine and to 18.0 +/- 3.0 mmHg on latanopro st (p = 0.06). In addition, mean peak pressure was similar between pilocarp ine (21.0 +/- 2.9 mmHg) and latanoprost (20.5 +/- 3.8 mmHg) (p = 0.20). Sid e-effects were similar with the exception of blurred vision, which was only found with pilocarpine (10%). Compliance was more difficult with pilocarpi ne. Conclusion In exfoliation glaucoma, as a third-line adjunctive therapy adde d to timolol and dorzolamide, latanoprost and pilocarpine have similar diur nal efficacy. However, latanoprost provides a greater morning pressure redu ction.