■ Researcher Christine Ha of the Rutgers University School of Medicine’s department of ophthalmology set out to determine if the addition of latanoprostene bunod (Vyzulta; Bausch + Lomb) in patients already on multiple glaucoma medications could be effective in lowering IOP. Vyzulta is a new medication whose main additional mechanism is nitric oxide donation. Its downstream effect improves trabecular meshwork outflow. Published studies have proven its efficacy alone as primary therapy in treatment-naïve eyes. This study retrospectively investigated the long-term efficacy of adjunctive use of Vyzulta in refractory cases of glaucoma at a tertiary care glaucoma clinic. Refractory cases were judged as requiring ≥3 topical medications.

Patients’ baseline characteristics prior to add-on therapy were recorded and included type of glaucoma and prior topical, laser, and surgical treatments. A baseline IOP was calculated by taking the average of the 2 most recent IOP measurements prior to latanoprostene bunod add-on treatment. IOP was measured at 3-, 6-, and 12-month intervals ±4 weeks.

Overall, 53 eyes in 36 patients were included in this analysis. Mean age (±SD) was 72.1±11.0. Eighteen (50%) patients were Caucasian, 13 (36%) African American, 2 (5%) Hispanic, 2 (5%) Indian American, and 1 (2%) Asian. Glaucoma diagnoses were as follows: 45 (85%) primary open angle, 6 (11%) neovascular, and 2 (4%) uveitic. Mean IOP mmHg (±SD) at baseline was 19.9±6.0. Follow-up mean IOPs mmHg (±SD) are as follows: 3-month 17.3±5.5 in 49 eyes, 6-month 17.2±6.6 in 35 eyes, and 12-month 16.1±4.5 in 28 eyes.

The researchers, who reported their findings at the 2021 virtual ARVO meeting, concluded that adjunctive use of latanoprostene bunod in refractory glaucoma showed clinically and statistically significant IOP reductions. This study suggests that adding latanoprostene bunod to eyes with previous medical or surgical treatment can provide longer term IOP reduction. Further analysis is required to fully understand the effect of latanoprostene bunod in refractory glaucoma.