The Short-Term Effect of Prostaglandin Analog Monotherapy on Corneal Biomechanical Properties in Normal Tension Glaucoma Patients

Jung Yul Park; Ji Woong Lee; Jong Hoon Shin

doi:10.3341/jkos.2016.57.3.477

Journal List > J Korean Ophthalmol Soc > v.57(3) > 1010536

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Park, Lee, and Shin: The Short-Term Effect of Prostaglandin Analog Monotherapy on Corneal Biomechanical Properties in Normal Tension Glaucoma Patients

Original Article

J Korean Ophthalmol Soc 2016;57(3):477-484.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.3.477

The Short-Term Effect of Prostaglandin Analog Monotherapy on Corneal Biomechanical Properties in Normal Tension Glaucoma Patients

Jung Yul Park, MD, Ji Woong Lee, MD, PhD, Jong Hoon Shin, MD

Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

Address reprint requests to Jong Hoon Shin, MD, Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 49241, Korea, Tel: 82-51-240-7324, Fax: 82-51-242-7341, E-mail: jjongggal@naver.com

Received 15 May 2015 Revised 13 October 2015 Accepted 14 January 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effects of short-term prostaglandin analogues treatment on the corneal biomechanics of patients with normal tension glaucoma.

Methods

This study included 52 eyes of 52 patients who were diagnosed with normal tension glaucoma. All patients were divided into two groups; one group (27 eyes) received tafluprost while the other group (25 eyes) received travoprost. Intraocular pressure, Biomechanical properties were measured by using goldmann applanation tonometer, ocular response analyzer before treatment and at 8-week after treatment.

Results

The mean decrease in intraocular pressure, Goldmann-correlated IOP (IOPg), corneal-compensated intraocular pressure by using Goldmann applanation tonometer, and Ocular response analyzer were statistically significant in total patients, tafluprost, and travoprost group after using prostaglandin analogues (p < 0.001, p < 0.001, p < 0.001, respectively). Corneal hysteresis showed no statistical differences after treatment in total, tafluprost and travoprost group but corneal resistance factor (CRF) showed statistically significant decrease after using prostaglandin analogues in total, tafluprost, and travoprost group (p < 0.001, p = 0.025, p < 0.001). Upon multivariate analysis, the higher initial IOPg and the lower initial CRF checked, the variation of CRF (CRF in baseline – CRF at 8 weeks) got higher (β = 0.134, p = 0.017).

Conclusions

It is needed to carefully monitor and evaluate the effects of prostaglandin analogues on intraocular pressure associated with initial intraocular pressure and the changes of CRF after prostaglandin treatment in normal tension glaucoma patients. CRF is sensitive factor to short-term changes of intraocular pressure after prostaglandin analogues treatment, and it is required to consider the properties of CRF when we evaluate between progression of glaucoma and corneal biomechanical properties.

Keywords: Corneal biomechanical properties, Corneal Hysteresis, Corneal resistance factor, Normal tension glaucoma, Prostaglandin analogue

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Figure 1.

Comparison of intraocular pressure (IOP) changes after dosing of tafluprost and travoprost. (A) Intraocular pressure

Figure 2.

A relationship between CRF changes and baseline IOPg. A scatter plot illustrates significantly positive relationships between IOPg measurements in baseline and CRF variation (CRF in baseline - CRF in 8 weeks using treatment) for each patient treated with tafluprost or travoprost. CRF = corneal resistance factor; IOPg = Goldmann-correlated intraocular pressure.

Table 1.

Clinical and ocular characteristics of the normal tension glaucoma patients groups

	Total (n = 52)	Tafluprost (n = 27)	Travoprost (n = 25)	p-value
Age (years)	53.8 ± 15.2	52.3 ± 14	55.1 ± 16.3	0.301^*
Female (%)	44.2	43.0	41.4	0.788^†
CCT (μm)	555 ± 39.2	555 ± 40	554 ± 39.2	0.697^*
Axial length (mm)	24.84 ± 1.71	24.79 ± 1.71	24.89 ± 1.75	0.800^*
Baseline IOP (mm Hg)	16.29 ± 3.70	16.44 ± 3.68	16.15 ± 3.79	0.795^*
SE (diopters)	−2.43 ± 3.22	−2.76 ± 3.36	−2.12 ± 3.12	0.442^*
Visual field index	82.58 ± 15.38	81.39 ± 14.99	83.69 ± 15.95	0.258^*
MD (dB)	−7.39 ± 4.96	−7.4 ± 5.04	−7.38 ± 4.98	0.491^*
PSD (dB)	7.34 ± 4.62	7.71 ± 4.36	6.99 ± 4.91	0.232^*

Values are presented as mean ± SD unless otherwise indicated.

CCT = central corneal thickness; IOP = intraocular pressure; SE = spherical equivalent; MD = mean deviation; PSD = pattern standard deviation; dB = decibel.

^* Mann-Whitney U-test between travoprost and tafluprost group;

^† Chi-square test between tafluprost and travoprost group.

Table 2.

Corneal biomechanical parameters by Ocular Response Analyzer in normal tension glaucoma patient groups; baseline and after 8 weeks of total patients, tafloprust, and travoprost

	Baseline	8 weeks	p-value^*
Total
IOPcc (mm Hg)	17.02 ± 4.13	14.70 ± 3.26	<0.001
IOPg (mm Hg)	16.59 ± 4.48	13.90 ± 3.57	<0.001
GAT (mm Hg)	16.29 ± 3.70	14.13 ± 3.14	<0.001
CH (mm Hg)	10.29 ± 1.65	10.29 ± 1.79	0.981
CRF (mm Hg)	10.64 ± 2.07	9.85 ± 2.08	<0.001
Tafluprost
IOPcc (mm Hg)	17.16 ± 4.10	15.20 ± 3.41	0.001
IOPg (mm Hg)	16.97 ± 4.14	14.50 ± 3.57	<0.001
GAT (mm Hg)	16.44 ± 3.68	14.68 ± 3.4	0.002
CH (mm Hg)	10.49 ± 1.65	10.36 ± 1.81	0.542
CRF (mm Hg)	10.92 ± 1.80	10.07 ± 1.98	0.025
Travoprost
IOPcc (mm Hg)	16.87 ± 4.23	14.25 ± 3.10	0.001
IOPg (mm Hg)	16.24 ± 4.84	13.34 ± 3.53	<0.001
GAT (mm Hg)	16.15 ± 3.79	13.63 ± 2.86	0.033
CH (mm Hg)	10.11 ± 1.67	10.23 ± 1.80	0.633
CRF (mm Hg)	10.39 ± 2.30	9.66 ± 2.19	<0.001

Values are presented as mean ± SD unless otherwise indicated. IOPcc = corneal-compensated intraocular pressure; IOPg = Glodmann-correlated intraocular pressure; GAT = Goldmann applanation tonometer; CH = corneal hysteresis; CRF = corneal resistance factor.

^* Paired-t test between baseline and 8 weeks using tafluprost or travoprost.

Table 3.

Result of multiple linear regression analysis with CRF variations obtained with Ocular Response Analyzer as dependent variable in normal tension glaucoma patients being treated with tafluprost or travoprost

	CRF variations (initial CRF–final CRF)
	β	p-value
Model 1
Age	−0.019	0.192
IOPcc	0.101	0.118
GAT	0.006	0.936
AXL	0.076	0.557
Model 2
Age	−0.018	0.211
IOPg	0.134	0.017^*
GAT	−0.034	0.610
AXL	0.104	0.380

Multiple regression models for analyzing relationship between CRF variations and other clinical variables including intraocular pressure parameters (IOPcc in Model 1, IOPg in Model 2).

CRF = corneal resistance factor; IOPcc = corneal-compensated intraocular pressure; GAT = Goldmann applanation tonometer; AXL = axial length; IOPg = Glodmann-correlated intraocular pressure.

^* By enter method.

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