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Glaucoma
cardiogenic shock.
49
An oral beta-blocker taken at the same time can drop due to adverse events.
53
A further study from the same database
potentiate these cardiac effects. showed that fixed-combination timolol/latanoprost had the greatest
persistency of use, with 64.2% of patients prescribed the preparation
The prostaglandin analogues have achieved notoriety for their still using it at 60 months.
54
A large European five-year study looked at
association with iris and eyelid darkening and thickening and the incidence of iris pigmentation from baseline, darkening,
lengthening of the eyelashes. Darkening of the iris is thought to be lengthening and thickening of the eyelashes or pigmentation of peri-
due to an increase in the amount of melanin within a stable iris orbital skin and spontaneously reported adverse events or serious
melanocyte population and is irreversible although entirely adverse events.
33
Presented in abstract form, this study, involving 974
harmless.
6
However, one study has suggested that the iris patients, found that 42.6% of them developed overall increased iris
pigmentation may be reversible on cessation of the drop.
50
pigmentation, 58.1% developed eyelash change and 5.2% developed
Lengthening and thickening of the lashes is thought to occur least in peri-orbital skin changes. One patient developed cystoid macular
latanoprost of all the prostaglandin analogues and is reversible on oedema. Overall, this study concluded that, even after 60 months of
cessation of the drop. Patients often have a positive response to this treatment, fixed-combination timolol/latanoprost was safe and well
change, although lashes may occasionally be so long as to interfere tolerated for patients with primary open-angle glaucoma and ocular
with spectacle wear and even accurate drop administration.
51
hypertension. This is believed to be the longest study to date
examining these issues.
Early studies on fixed-combination timolol/latanoprost cited the
occurrence of burning, conjunctival hyperaemia, ocular itching, The Future for Fixed-combination
tearing, dry eye, eyelid laxity, blurred vision, floaters, blepharitis, Timolol/Latanoprost
diplopia, sinus allergies
35
and even back pain.
52
Other more serious It is only eight years since fixed-combination timolol/latanoprost was
adverse events can include changes in refractive error, upper launched, and during this time it has established a good safety profile.
respiratory tract infection, cardiac failure, tachycardia, blood Although evidence of its efficacy in lowering IOP has at times been
pressure or pulse rate changes and increased iris pigmentation.
14,50
conflicting, the benefits it offers in terms of ease of compliance and
Patients were withdrawn from one study with finger and arm reduced exposure to preservatives have confirmed it as a useful
fractures.
13
Night-time use of a beta-blocker has been implicated as addition to the therapeutic armamentarium in many parts of the
contributing to progression in some cases of glaucomatous optic world. Following the introduction of other combination beta-
neuropathy by the reduction of ocular perfusion pressure.
45
adrenergic receptor blocker/prostaglandin analogue products, such
as fixed-combination travoprost/timolol and fixed-combination
However, significant adverse effects appear to be very uncommon. timolol/bimatoprost, as well as the adrenergic receptor blocker/
Glasgow Royal Infirmary’s patient database provides ‘real-life’ data on carbonic anhydrase timolol/brinzolamide fixed combination, the
patients being seen in clinics and suggests that fixed-combination market for fixed-combination products is becoming more crowded.
timolol/latanoprost is among the best tolerated glaucoma Further high-quality comparative studies will be required to evaluate
medications, with only 8.6% of patients having to discontinue the the long-term relative strengths and weaknesses of these products. n
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