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Tytuł:
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Intraocular Pressure Following Prerandomization Glaucoma Medication Washout in the HORIZON and COMPASS Trials.
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Autorzy:
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Johnson TV; Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: .
Jampel HD; Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
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Źródło:
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American journal of ophthalmology [Am J Ophthalmol] 2020 Aug; Vol. 216, pp. 110-120. Date of Electronic Publication: 2020 Apr 11.
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Typ publikacji:
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Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 1999- : New York, NY : Elsevier Science
Original Publication: [Chicago, etc., Ophthalmic Pub. Co., etc.]
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MeSH Terms:
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Antihypertensive Agents/*therapeutic use
Glaucoma, Open-Angle/*drug therapy
Intraocular Pressure/*drug effects
Administration, Ophthalmic ; Aged ; Aged, 80 and over ; Female ; Glaucoma Drainage Implants ; Glaucoma, Open-Angle/surgery ; Humans ; Intraocular Pressure/physiology ; Male ; Middle Aged ; Ophthalmic Solutions ; Prospective Studies ; Prosthesis Implantation ; Risk Factors ; Single-Blind Method ; Tonometry, Ocular ; Visual Field Tests
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Substance Nomenclature:
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0 (Antihypertensive Agents)
0 (Ophthalmic Solutions)
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Entry Date(s):
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Date Created: 20200415 Date Completed: 20201002 Latest Revision: 20201002
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Update Code:
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20240104
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DOI:
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10.1016/j.ajo.2020.04.008
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PMID:
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32289292
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Purpose: To assess the effectiveness of topical ocular hypotensive medications in patients with open-angle glaucoma and to identify factors associated with postwashout intraocular pressure (IOP) elevation.
Design: Secondary analysis of prerandomization data from 2 prospective, multicenter, randomized clinical trials.
Methods: Fourteen hundred subjects (1,400 eyes, 781 from the HORIZON study of the Hydrus micro-stent and 619 from the COMPASS study of the Cypass micro-stent) with primary open-angle glaucoma who were using 0-4 classes of topical IOP-lowering medication underwent Goldmann applanation tonometry before and after a protocol-defined washout period.
Results: The mean (standard deviation) age was 70.7 (8.0) years and 55.6% were female. The change in IOP following washout for patients using 0 (n = 100), 1 (n = 705), 2 (n = 355), 3 (n = 214), or 4 (n = 26) medications was 0.2 (2.8), 5.7 (3.3), 6.9 (3.7), 8.8 (5.0), and 9.5 (4.1) mm Hg, respectively (P < .001, Kruskal-Wallis test). Postwashout IOP change was similar between the HORIZON and COMPASS cohorts. No difference in postwashout IOP change was detected among individual prostaglandin analogues in patients on monotherapy. A generalized linear model identified the following factors to be associated with greater IOP rise upon medication washout: greater number of glaucoma medications, higher unmedicated IOP, thinner central corneal thickness (CCT), lack of prior selective laser trabeculoplasty (SLT), and male sex.
Conclusions: Cessation of glaucoma medications results in a dose-dependent IOP increase in treated open-angle glaucoma patients. Two independent clinical trial cohorts exhibit similar levels of IOP elevation upon washout, using standardized methodology to estimate real-world medication effectiveness. Thicker CCT and history of SLT may predict reduced response to IOP lowering medications.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
