Topical prostaglandin analogs (PGAs) are recommended as first-line therapy for the treatment of glaucoma. However, many patients do not achieve adequate IOP control with monotherapy and require additional agents. Combination therapy involving the use of two individual eye drops makes the medication instillation regimen complex, often leading to reduced adherence to treatment. Lack of adherence leads to poor outcomes. Fixed combinations of glaucoma pharmacotherapies can simplify the dosing regimen, increase adherence, and improve the quality of life (QoL). Latanoprost 0.005% and timolol maleate 0.5% fixed combination (LTFC) was the first PGA/βeta-blocker (BB) combination, launched in the European Union in 2001, and continues to be widely used. Studies have reported improved QoL and patient satisfaction with LTFC compared to monotherapy or other combination therapies. A high level of satisfaction with LTFC concerning tolerability and good adherence has also been reported. In several studies comparing LTFC with other monotherapies, LTFC consistently showed a higher reduction in intraocular pressure (IOP). Some studies have also shown that LTFC leads to a greater reduction in IOP than other combination therapies. Thus, LTFC can be useful in the management of patients with inadequate IOP control on monotherapy.

Ciliary madarosis, characterized by the partial or complete loss of eyelashes, has limited treatment options, especially in pediatric cases. Prostaglandin analogues, primarily used in glaucoma treatment, have shown potential as a novel approach for promoting eyelash regrowth due to their hypertrichotic effects. We report the case of a 5-year-old boy presenting with isolated eyelash loss on the right upper eyelid. Following unremarkable systemic and ophthalmologic evaluations, the child was treated with nightly latanoprost 0.005% eye drops applied to the eyelid margin. After three months, eyelash regrowth was observed, with no adverse effects. This case highlights the potential of latanoprost as a viable treatment for pediatric ciliary madarosis. Further research is warranted to establish guidelines for its off-label use in eyelash loss.

Rho-associated kinase (ROCK) inhibitors have gained popularity as novel treatment options in the management of glaucoma and corneal endothelial disorders. Among the various ocular side effects, reticular corneal epithelial edema has been most frequently reported, mainly after treatment with netarsudil. To explain the potential mechanisms, we comparatively analyzed the effects of ripasudil and netarsudil on corneal endothelial and epithelial function in vitro. Primary human corneal endothelial and epithelial cells were incubated with netarsudil dihydrochloride and ripasudil hydrochloride dihydrate for up to 7 days. Gene and protein expression analyses were performed by real-time PCR and immunocytochemistry. Functional assays assessed the cell migration, proliferation, viability, Na[+]/K[+]-ATPase activity, transcellular electrical resistance, and FITC-dextran permeability. Reticular bullous corneal epithelial edema was observed in a patient following netarsudil 0.02%/latanoprost 0.005% ophthalmic solution (Roclanda[®]) for elevated intraocular pressure. In the subsequent laboratory analyses, both netarsudil and ripasudil were found to improve the corneal endothelial pump and barrier function, but they showed differential effects on corneal epithelial cells. Whereas ripasudil improved the epithelial barrier function by upregulating major components of the tight and adherens junctions and reducing paracellular permeability, netarsudil had no or even adverse effects on the epithelial barrier properties by downregulating the expression levels of cell-junction-associated genes. The expression changes normalized after discontinuation of ROCK inhibitors. The findings support the concept that ROCK inhibitors can act as a double-edged sword by having beneficial effects on corneal endothelial cells and adverse effects on epithelial cells.

Frequent topical administration of hypotensive eye drops in glaucoma patients may lead to the development of dry eye disease (DED) symptoms, because of tear film destabilization and the adverse effects associated with antiglaucoma formulations. To address all this, in the current study preservative-free latanoprost-loaded (0.005 % w/v) synthetic phosphatidylcholine (1,2-dioleoyl-sn-glycero-3-phosphocholine 0.75 % w/v, 1,2-dimyristoyl-sn-glycero-3-phosphocholine 0.25 % w/v) liposomes dispersed in the mucoadhesive polymer hyaluronic acid (0.2 % w/v), containing the osmoprotective ingredients betaine (0.40 % w/v) and leucine (0.90 % w/v) (LAT-HA-LIP), have been prepared and further characterised. Permeation and retention evaluations on a validated ex vivo porcine eye model revealed that the active metabolite latanoprost acid was quantified only starting from LAT-HA-LIP once passing conjunctiva, sclera and choroid compared to the marketed latanoprost (0.005 % w/v) benchmark (MF). The liposomal formulation outperformed MF when applied to the corneal tissue. Additionally, distribution and interactions within corneal and scleral tissues were investigated by means of two-photon microscopy with liposomal formulations containing coumarin-6. Furthermore, acute and chronic tolerance studies on rabbits revealed no signs of discomfort or ocular damage. Schirmer's test, tear osmolarity, tear breakup time (TBUT) and fluorescence staining evaluated through the Oxford grading scale, were assessed as DED diagnostic parameters over a 25-day monitoring period; LAT-HA-LIP consistently maintained levels comparable to physiological solution (0.9 % w/v NaCl) used as control, with a slight increase of TBUT values from day 15 (6.00 ± 0.63 s for control, 7.00 ± 0.78 s for LAT-HA-LIP at day 15, p = 0.0066). A daily topical application of LAT-HA-LIP for 15 consecutive days, effectively lowered IOP in a sustained way (2.51-3.88 mmHg mean IOP reduction over the 5-15-day period). These results highlight the clinical relevance of the proposed technological platform, able to provide IOP reduction during the simulated long-term administration and simultaneous ocular surface protection with potential for the treatment of glaucoma.

Purpose: To compare intraocular pressure (IOP), ocular surface disease (OSD) parameters, and safety in patients with open-angle glaucoma (OAG)/ocular hypertension (OH) and concurrent OSD treated with preservative-free latanoprost 0.005% cationic emulsion (PF-latanoprost-E) or travoprost-Z 0.004% ophthalmical solution containing a soft preservative system. Methods: Patients with OAG/OH and OSD were randomized to treatment with PF-latanoprost-E or travoprost-Z nightly for 3 months. Outcomes included mean diurnal IOP reduction; OSD endpoints, including symptom improvement, tear break-up time (TBUT), and corneal fluorescein staining (CFS) score; and safety after 1 and 3 months. Results: A total of 105 patients were randomized, 51 to PF-latanoprost-E and 54 to travoprost-Z. IOP reductions (LS mean differences) at 3 months were numerically greater in the PF-latanoprost-E than in the travoprost-Z group at 8AM (7.2 versus 6.0 mmHg), 10AM (6.7 versus 5.9 mmHg), and 4PM (6.0 versus 5.4 mmHg). LS mean changes in IOP from baseline in both groups at 1 and 3 months, however, were comparable. Mean ± SD CFS scores on the Ora scale at month 3 showed significantly greater reductions in the PF-latanoprost-E than in the travoprost-Z group (-1.07 ± 1.863 versus -0.16 ± 2.553 P = 0.0461). The mean TBUT at month 3 showed similar improvements in both groups (1.1 versus 1.0 s, P > 0.05). OSD symptoms improved but did not differ significantly in the two groups. Overall safety was comparable in both groups. Conclusion: PF-latanoprost-E effectively and safely lowered IOP and improved OSD parameters in patients with OAG/OH. These findings provide evidence for the beneficial effects of this new formulation of latanoprost in glaucoma patients with OSD.