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Latanoprost, a prostaglandin F2α analogue, has proved to be an effective ocular hypotensive drug. 1-7 Its main mechanism for reducing intraocular pressure (IOP) is an increase in the uveoscleral outflow. When administered to monkey eyes latanoprost markedly increased uveoscleral outflow, 8 and a corresponding effect has indirectly been demonstrated in humans. 9 Latanoprost has not been found to alter the aqueous humour production to a clinically significant extent. 9 10 In long term studies latanoprost, when applied as a once daily dose of a 0.005% concentration, reduced IOP at least as effectively as β adrenergic antagonists. 1-3 Previous studies have shown that adding PGF 2α isopropyl ester to timolol caused a further reduction of the IOP. 11 12 A marked additional IOP reducing effect of latanoprost added to timolol was also seen in a 3 month study by Almet al , 1 in which once daily was found to be the optimal dosage regimen for latanoprost.
In many patients topical β adrenergic antagonists alone do not sufficiently lower IOP, and additional medications have to be prescribed. 13 In current practice, pilocarpine is frequently used as "add on" therapy and it may be of interest to know whether a simple switch from β adrenergic antagonist to latanoprost is as effective. Administration of several medications may be inconvenient for the patient, 14 and long term maintenance with monotherapy in the management of glaucoma would, therefore, be advantageous for the patient.
The purpose of the present study was to compare the effect on IOP of treatment with latanoprost or timolol-pilocarpine in glaucoma patients or patients with ocular hypertension inadequately controlled on topical β adrenergic antagonists. In addition, ocular and systemic safety variables were monitored and reported throughout the 6 week study period.
Patients and methods
This multicentre study was designed as a 6 week randomised, observer masked comparison of latanoprost with timolol-pilocarpine treatment. A total of 23 centres were involved in the study; 17 centres in France and six centres in Sweden. After obtaining approval from the appropriate regulatory authorities and ethics committees for each centre, signed informed consent was obtained from all patients before entering the study. The study protocol followed the guidelines of the Declaration of Helsinki. After a run in period of...