Key takeaways:
- In contrast with prostaglandin analogs, the danger for a brand new uveitis analysis was increased with different topical glaucoma drugs.
- Acute flares in persistent uveitis had been least widespread with prostaglandin analogs.
Prostaglandin analogs had been related to a decrease threat for uveitis in contrast with different topical glaucoma drugs, in accordance with a retrospective research of greater than 64,000 sufferers revealed in Ophthalmology Glaucoma.
“The connection between glaucoma drugs and uveitis incidence is nuanced and has been the topic of appreciable debate and investigation,” Muhammad Z. Chauhan, MD, MS, of the Harvey and Bernice Jones Eye Institute on the College of Arkansas for Medical Sciences, and colleagues wrote. “Regardless of the medical significance, large-scale research that discover the incidence of uveitis throughout totally different courses of glaucoma drugs inside numerous populations are scarce.”
Information derived from Chauhan MZ, et al. Ophthalmol Glaucoma. 2025;doi:10.1016/j.ogla.2024.10.010.
Chauhan and colleagues analyzed knowledge from 10 well being techniques included within the Sight Outcomes Analysis Collaborative Ophthalmology Information Repository, evaluating the incidence of latest uveitis diagnoses amongst 64,517 sufferers (imply age, 67.3 years; 59.2% girls) inside 3 months of initiating topical glaucoma treatment, together with alpha agonists (16.7%), beta-blockers (17.5%), prostaglandin analogs (62%) and carbonic anhydrase inhibitors (3.7%).
Total, 567 sufferers (0.87%) had been newly recognized with uveitis inside 3 months of beginning treatment. The uveitis fee was lowest with prostaglandin analogs (0.32%), adopted by alpha agonists (1.63%), carbonic anhydrase inhibitors (1.68%) and beta-blockers (1.95%).
In contrast with prostaglandin analogs, there was a sixfold increased threat for uveitis related to using beta-blockers or carbonic anhydrase inhibitors, whereas the danger was 5 instances increased with alpha agonists (P < .001 for all). The comparisons had been adjusted for sociodemographic elements together with gender, race/ethnicity, urbanicity and age when beginning the treatment.
In sufferers with a historical past of persistent uveitis, these beginning prostaglandin analogs had the bottom fee of acute flares inside 3 months (0.35%), adopted by these on carbonic anhydrase inhibitors (1.92%), alpha agonists (1.97%) and beta-blockers (2.4%).
“Our analysis contributes to a rising physique of proof that challenges the notion of [prostaglandin analogs] as a possible threat issue for uveitis exacerbation in glaucoma sufferers with or with no historical past of uveitis in numerous affected person populations,” Chauhan and colleagues wrote. “The medical implications of those findings are vital, calling for a reevaluation of therapy paradigms of glaucoma, particularly in these with preexisting irritation.
“In uveitis, the trabecular pathway is considerably extra compromised attributable to irritation, pigment dispersion and probably as a consequence of corticosteroid use than the uveoscleral outflow pathway. This makes [prostaglandin analogs], with their predilection for the uveoscleral route, well-suited for decreasing IOP in uveitis.”
Perspective
The affiliation between prostaglandin analogs (PGAs) and irritation stays a extensively held concern, usually influencing the choice to keep away from their use in choose glaucoma sufferers with a historical past of irritation. This research affords compelling large-scale knowledge that challenges that notion. Sufferers prescribed PGAs didn’t exhibit an elevated threat of growing subsequent uveitis in contrast with these handled with different courses of glaucoma drugs. This discovering calls into query the notion that PGAs are proinflammatory as one would count on a big, heterogenous inhabitants would reveal any such affiliation of irritation with PGAs over any of the opposite drugs.
The secondary evaluation utilizing a smaller subset of sufferers with a historical past of iridocyclitis revealed that these handled with PGAs skilled decrease charges of flares than these receiving any of the opposite treatment courses. This discovering would favor using PGAs on this inhabitants, though the authors state they may not rule out choice bias on the a part of the prescribers.
Whereas this research raises necessary questions relating to PGA use in sufferers with a historical past of uveitis, continued warning is warranted as the character of this research didn’t handle the numerous etiology and severity that embody uveitis as an entire.
Joe L. Wheat, OD, PhD, FAAO
Affiliate professor, College of Houston School of Optometry
Member, Optometric Glaucoma Society
Disclosures: Wheat experiences no related monetary disclosures.
Sources/Disclosures
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Chauhan MZ, et al. Ophthalmol Glaucoma. 2025;doi:10.1016/j.ogla.2024.10.010.
Disclosures:
Chauhan experiences no related monetary disclosures. Please see the research for all different authors’ related monetary disclosures.
