Angle Closure Glaucoma Case Study

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Angle-closure glaucoma is defined as an obstruction of the flow of aqueous humor in the eye due to the iris and trabecular meshwork being too close together which creates a closed angle where 270 degrees or more of the angle is occluded.1 Occlusion of the angle causes the intraocular pressure (IOP) to elevate. Optic nerve damage can occur if IOP is greater than 40 mmHg and permanent vision loss can occur if an individual's IOP is greater than 60 mmHg.2 The incidence of angle-closure glaucoma is variable but it is seen more frequently in individuals of Inuit, Chinese, and Asian-Indian descent. In the United States, only a small number of individuals with glaucoma suffer from angle-closure glaucoma. Most individuals with angle-closure glaucoma are asymptomatic but some may develop acute primary angle closure due to a sudden increase in IOP.3 Individuals that develop this could present with vomiting, blurry vision, halos around lights, vomiting, nausea, and ocular pain.1 The current standard of care includes laser peripheral iridotomy as first-line treatment for angle-closure glaucoma. The procedure will create a hole in the iris to eradicate the blockage and allow proper flow of the aqueous humor.1,2 However, individuals that undergo an iridotomy may still have an elevated IOP which can be treated with topical beta-blockers, alpha-2 agonist, carbonic anhydrase inhibitors, and prostaglandin analogues.1,2,3 Latanoprost is a synthetic selective F2ɑ prostaglandin analogue prodrug which is approved to treat open-angle glaucoma and ocular hypertension.4,5,6 There is limited evidence on the safety and efficacy of latanoprost use in patients with angle-closure glaucoma, inflammatory glaucoma, and neovascular glaucoma. Latanoprost decreases IOP by increasing the outflow of aqueous humor by acting on the FP receptor, not by reducing aqueous humor formation.4,6 Latanoprost has been shown to decrease IOP 23-35% from baseline in patients with a previously elevated IOP.6 Studies that have evaluated commercially available dosage forms of latanoprost showed 1.5mcg daily (1 drop once daily) causes the largest reduction in IOP and twice daily administration has been shown to be equally effective. The recommended dosing of Latanoprost in adults is 1 drop applied topically to the affected eye daily in the evening for patients with open-angle glaucoma or ocular hypertension.4,5,6 It has been shown that more frequent use of latanoprost may decrease the drug's ability to lower IOP. If a patient were to miss a dose, they should wait until the following evening to apply latanoprost instead of trying …show more content…
Latanoprost reaches a peak concentration in the aqueous humor within 2 hours of administration. A reduction in IOP begins within 3-4 hours after administration and peaks within 8-12 hours after administration. The portion of drug that is systemically absorbed is completely hydrolyzed to the acid form of the drug by esterases once the drug reaches the plasma and enters the liver. The portion of the drug that reaches systemic circulation has been shown to cause minimal side effects.6 The elimination half-life of latanoprost is 3-4 hours and the drug metabolites are renally excreted.5,6 Urinalysis has shown that only the drug metabolites are primarily found in the urine instead of pure drug or the acid form of the …show more content…
If another topical ophthalmic agent is used in conjunction with latanoprost, their administration should be separated by 5 minutes. Any topical ophthalmic agent containing thimerosal which is used in conjunction with latanoprost should also be administered 5 minutes apart to avoid possible

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