Originally approved for second-line therapy when introduced in 1996, latanoprost has been FDA approved as a first-line treatment of open-angle glaucoma or ocular hypertension since 2002. Travoprost and bimatoprost were initially approved by the FDA for second-line therapy, and subsequently both drugs have been approved for first-line treatment.

Clinical studies have also demonstrated that PGs lower IOP in patients with normal tension glaucoma,21-24 exfoliation syndrome,25-31 pigment dispersion syndrome,17,27,31 and chronic angle-closure glaucoma.32-35 There are limited reports of clinical experience with the use of latanoprost in other types of glaucoma.28 Caution is recommended in uveitic glaucoma, although some studies demonstrate safety and efficacy of PGs in uveitic glaucoma.36 PGs, like other glaucoma medications, may be less effective in pediatric patients.37

PG analogs have several advantages over other ocular hypotensive medications. Their main advantage over the beta blockers is the apparent lack of systemic side effects. Compared with beta blockers, PG analogs are more potent and effective ocular hypotensive agents with once-a-day dosing, and they are equally well tolerated by patients. Whereas beta blockers do not reduce aqueous flow during sleep, PGs are as effective at night as during the day.38,39 Reducing IOP at night may have the added advantage of reducing glaucomatous damage during sleep when ocular perfusion pressure may be reduced secondary to decreased systemic blood pres-sure.40 Because of their mechanism of action, PG analogs potentially can reduce IOP below episcleral venous pressure, unlike medications that increase outflow facility. This, along with their more favorable effect on ocular perfusion pressure, presents a potential advantage in normal tension glaucoma, which may require very low IOPs for adequate control.22-24

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