Prostaglandins and Hypotensive Lipids

Abstract

The prostaglandin-related agents, or hypotensive lipids, are a relatively new class of ocular hypotensive agents. Four agents have been approved for clinical use in the United States: two prostaglandin analoques (latanoprost: 1996, travoprost:2001), prostamide (bimatooprost: 2001) and docosanoid (unoprostone: 2000). Latanoprost, which was the first prostaglandinagent for glaucoma treatment, has undergone extensive clinical trials for efficacy, drug interaction and side effects and also has the most extensive clinical experience. The mechanism of action is that these drugs increase uveoscleral outflow by remodeling the extracellular matrix in the uveosscleral outflow pathway which results in increased spaces between the muscle fascicles.Whether there are other mechanisms of action of these drug is not fully understood. The efficacy of latanoprost, travoprost and bimatoprost, that are used once a day, is superior to topical beta-blockers. The drift in effectiveness of intraocular pressure lowering (tachyphylaxis) have not been observed in this drug class, and there is no peak and trough effect. They have mild extraocular irritation, and virtually no systemic side effect.