Category:Glaucoma medications: Difference between revisions
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The transformative class of contemporary glaucoma medicine was the prostaglandin analogue. The Hungarian-American pharmacologist [[wikipedia:László Z. Bitó|László Bitó]] at Columbia, working in the 1970s on the effects of prostaglandins on intraocular pressure, observed paradoxically that low concentrations of certain prostaglandin F2α analogues lowered, rather than raised, the pressure by markedly enhancing the uveoscleral pathway of aqueous outflow.<ref name="bito1989">Bito LZ, Stjernschantz J, Resul B, Miranda OC, Basu S. The ocular effects of prostaglandins and the therapeutic potential of a new PGF2 alpha analog, PhXA41 (latanoprost), for glaucoma management. ''Journal of Lipid Mediators''. 1993 Jul;6(1-3):535-543. PMID 8358017.</ref> Bito's collaboration with [[wikipedia:Pharmacia|Pharmacia]] produced [[Latanoprost|latanoprost]] (Xalatan, 1996), the first prostaglandin analogue glaucoma medicine; [[Bimatoprost|bimatoprost]] (Lumigan, Allergan, 2001), travoprost (Alcon, 2001), and tafluprost followed. The class lowers intraocular pressure by 28 to 32 percent on once-daily evening dosing, has minimal systemic effect, and has displaced beta-blockers as the standard first-line medical therapy. The principal cosmetic side effects, progressive darkening of the iris (in genetically heterochromic eyes), darkening and lengthening of the eyelashes (an effect that bimatoprost is separately marketed under the trade name Latisse for cosmetic use), and periorbital fat atrophy with deepening of the upper lid sulcus, are recognised and are accepted in exchange for the IOP benefit. | The transformative class of contemporary glaucoma medicine was the prostaglandin analogue. The Hungarian-American pharmacologist [[wikipedia:László Z. Bitó|László Bitó]] at Columbia, working in the 1970s on the effects of prostaglandins on intraocular pressure, observed paradoxically that low concentrations of certain prostaglandin F2α analogues lowered, rather than raised, the pressure by markedly enhancing the uveoscleral pathway of aqueous outflow.<ref name="bito1989">Bito LZ, Stjernschantz J, Resul B, Miranda OC, Basu S. The ocular effects of prostaglandins and the therapeutic potential of a new PGF2 alpha analog, PhXA41 (latanoprost), for glaucoma management. ''Journal of Lipid Mediators''. 1993 Jul;6(1-3):535-543. PMID 8358017.</ref> Bito's collaboration with [[wikipedia:Pharmacia|Pharmacia]] produced [[Latanoprost|latanoprost]] (Xalatan, 1996), the first prostaglandin analogue glaucoma medicine; [[Bimatoprost|bimatoprost]] (Lumigan, Allergan, 2001), travoprost (Alcon, 2001), and tafluprost followed. The class lowers intraocular pressure by 28 to 32 percent on once-daily evening dosing, has minimal systemic effect, and has displaced beta-blockers as the standard first-line medical therapy. The principal cosmetic side effects, progressive darkening of the iris (in genetically heterochromic eyes), darkening and lengthening of the eyelashes (an effect that bimatoprost is separately marketed under the trade name Latisse for cosmetic use), and periorbital fat atrophy with deepening of the upper lid sulcus, are recognised and are accepted in exchange for the IOP benefit. | ||
The most recent pharmacological additions act on the trabecular meshwork directly. The Rho-associated kinase inhibitor [[wikipedia:Netarsudil|netarsudil]] (Aerie, 2017) lowers IOP by relaxing actomyosin contractility in the trabecular meshwork and Schlemm's canal, increasing trabecular outflow. The selective adenosine-A1 receptor agonist [[wikipedia:Trabodenoson|trabodenoson]] and the fixed-combination drops (netarsudil-latanoprost, brimonidine-timolol, dorzolamide-timolol, latanoprost-netarsudil) round out the contemporary pharmacopoeia. Selective laser trabeculoplasty has emerged in parallel as a first-line procedural alternative to chronic eye drops, and the LiGHT trial in 2019 found that primary SLT produced equivalent IOP control with a higher quality-of-life score than primary medical therapy. The | The most recent pharmacological additions act on the trabecular meshwork directly. The Rho-associated kinase inhibitor [[wikipedia:Netarsudil|netarsudil]] (Aerie, 2017) lowers IOP by relaxing actomyosin contractility in the trabecular meshwork and Schlemm's canal, increasing trabecular outflow. The selective adenosine-A1 receptor agonist [[wikipedia:Trabodenoson|trabodenoson]] and the fixed-combination drops (netarsudil-latanoprost, brimonidine-timolol, dorzolamide-timolol, latanoprost-netarsudil) round out the contemporary pharmacopoeia. Selective laser trabeculoplasty has emerged in parallel as a first-line procedural alternative to chronic eye drops, and the LiGHT trial in 2019 found that primary SLT produced equivalent IOP control with a higher quality-of-life score than primary medical therapy. The medicine-versus-laser-versus-incisional-surgery decision is now a genuine three-way choice rather than a sequential escalation. | ||
== Classes indexed == | == Classes indexed == | ||