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Medical Therapy for Glaucoma
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Jennifer E. Williamson, Janet B. Serle
Distribution of the prostaglandin analog unoprostone isopropyl (Rescula) was discontinued in the United States in 2004, and this drug was reintroduced in the United States in 2012. This drug was developed and initially marketed in Japan and is still marketed in Asia today. It is a less potent prostaglandin analog and has less of an effect on uveoscleral outflow than latanoprost, bimatoprost, or travoprost. In contrast to these three agents, when used clinically, unoprostone isopropyl was dosed twice daily; was less efficacious than timolol dosed twice daily; and thus was less efficacious than latanoprost, bimatoprost, or travoprost dosed once daily. The side effect profile of unoprostone isopropyl was similar to that of the other three prostaglandin drugs. The smaller ocular hypotensive effect of this agent may be due to the lower potency of unoprostone isopropyl at the FP receptor.
Efficacy of local prostaglandin analogues for vitiligo treatment: a systematic review and meta-analysis
Published in Expert Review of Clinical Pharmacology, 2022
Topical prostaglandin analogues such as latanoprost and bimatoprost are indicated for the treatment of intraocular hypertension and glaucoma. Their common adverse effects are hypertrichosis of the eyelashes and increased pigmentation of the iris and periocular areas. The reported frequency of eyelid pigmentation was 0% to 61.5% [4], which was not significantly different in relation to the use of five prostaglandin analogues (latanoprost, travoprost, tafluprost, bimatoprost, and unoprostone) in patients with glaucoma [5]. The proposed mechanisms by which the aforementioned prostaglandin F2α analogues (latanoprost and bimatoprost) cause adverse effects are anagen phase induction in hair follicles and melanogenesis stimulation [6,7]. These effects of glaucoma treatment have been widely investigated for their potential to treat alopecia and hypopigmentation disorders. In addition, early single-arm prospective studies have revealed remarkable effects of topical prostaglandin E2 analogues in the repigmentation of vitiligo lesions [8,9].
Current and new pharmacotherapeutic approaches for glaucoma
Published in Expert Opinion on Pharmacotherapy, 2020
Wesam Shamseldin Shalaby, Vikram Shankar, Reza Razeghinejad, L. Jay Katz
Topical prostaglandin analogs (PGAs) have been shown to decrease IOP by decreasing the intrinsic resistance of the uveoscleral outflow pathway. This effect may arise from its effects on the expression of matrix metalloproteinases within the ciliary body, leading to remodeling of the extracellular matrix and improved uveoscleral outflow [28]. PGAs include bimatoprost, latanoprost, tafluprost, and travoprost and have been shown to lower IOP by 20–35% [14,21]. These drugs are well tolerated with minimal systemic side effects. Unoprostone is an IOP-lowering prostanoid, unlike the PGAs, which are 20-carbon derivatives of the eicosanoid prostaglandin F2α, unoprostone is a 22-carbon derivative of docosahexaenoic acid with little to no affinity for the prostaglandin receptor [29]. Studies showed that it may work, in part, by activating potassium and chloride channels, leading to relaxation of the trabecular meshwork and increasing outflow of aqueous humor through the conventional pathway [29]. PGAs are used as the first-line agent for managing OAG and ocular hypertension, given their efficacy, tolerability, and once-daily dosing [30]. Neuroprotective effects have been noted in rat retinal ganglion cell cultures during glutamate exposure and hypoxia; however, quality clinical evidence in patients is lacking [31]. Adverse effects of PGAs include conjunctival hyperemia, eyelash growth, periorbital fat atrophy, eyelid skin hyperpigmentation, and irreversible iris hyperpigmentation. Non-ocular systemic side effects are minimal, and headaches are the most frequently reported [14].
Cost-effectiveness analysis of iStent trabecular micro-bypass stent for patients with open-angle glaucoma in Colombia
Published in Current Medical Research and Opinion, 2019
Jaime E. Ordóñez, Angélica Ordóñez, Urpy M. Osorio
Prostaglandin analogs are commonly used as first line treatment, due mainly to the lack of systemic side-effects and convenience of a daily dose, except for unoprostone, which usually promotes compliance. They are contraindicated in patients with a reactive airway or with renal failure. The adverse effects of this group of medications include ocular hyperpigmentation, conjunctival injection, allergic conjunctivitis, contact dermatitis, keratitis, possible reactivation of the herpes virus, uveitis, increased pigmentation of the iris, cystoid macular edema, periorbitopathy, and ocular surface disruption12.