0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Clinicopathologic Reports, Case Reports, and Small Case Series |

Acute Anterior Uveitis and Corneal Edema Associated With Travoprost FREE

William J. Faulkner, MD; Scott E. Burk, MD, PhD
[+] Author Affiliations

Section Editor: W. Richard Green, MD

More Author Information
Arch Ophthalmol. 2003;121(7):1054-1055. doi:10.1001/archopht.121.7.1054.
Text Size: A A A
Published online

Prostaglandin analogues have dramatically changed many clinicians' approach to glaucoma treatment. The combination of potency, once-daily dosing, and relatively few side effects make these appealing agents. The most frequently reported adverse reaction with travoprost is ocular hyperemia (occurring with a frequency of 35%-50% in populations studied). Decreased visual acuity, eye discomfort, foreign body sensation, pain, and pruritis are reported to occur with a frequency of 5% to 10%.1 Herein we report a case of acute iritis and corneal edema after only 5 doses of travoprost.

A 79-year-old white man had a history of atrial fibrillation and bladder carcinoma. The medications he was taking included digoxin, warfarin sodium, and verapamil. In 1983 he underwent planned extracapsular cataract extraction without an implant lens in the left eye. This was followed 1 year later by phacoemulsification with a posterior chamber intraocular lens placed in the right eye and a retinal detachment repair performed in his left eye. He was diagnosed as having open-angle glaucoma in both eyes in 1983. The glaucoma was well controlled medically over nearly 2 decades. Mild corneal guttata were first noted in 1993.

We saw him on January 2, 2002, for an eye examination. The visual acuity was 20/40 OD and 20/250 OS (without aphakic correction). Findings on slitlamp examination revealed clear corneas with 1-2+ guttata OU. The anterior chambers were quiet. The intraocular pressure was 20 mmHg OD and 23 mmHg OS while receiving a therapeutic regimen of 0.5% timolol maleate and brimonidine. When presented with the choice to try a new potent medication once a day instead of his current 2 medications, the patient elected to try travoprost once daily beginning on January 3. Two days later, he called complaining of mild redness, discomfort, and blurriness. He was advised of an adjustment period with this eyedrop and told to call back if symptoms did not improve. His symptoms worsened, and by January 8, his visual acuity had dropped to 20/100 OD. Slitlamp examination findings included 2+ conjunctival hyperemia, 2+ central corneal edema, and diffuse corneal folds in both eyes. There was 1-2+ "cell and flare" in the anterior chamber in both eyes. The intraocular pressure was 11 mmHg OD and 13 mmHg OS. Treatment with travoprost was discontinued and lotepredinol etabonate therapy was begun every 6 hours in both eyes. By January 17, the patient's discomfort resolved and visual acuity had improved to 20/50 OD, the corneal edema was clearing, and the anterior chambers were quiet. Treatment with timolol and brimonidine was restarted, and the loteprednol was tapered and stopped. By February 28 the corneal folds had completely cleared. Central corneal pachymetry measurements on that date were 587 µm OD and 541 µm OS. The endothelial cell count was 661 cells/mm2 OD and 708 cells/mm2 OS.

Inflammation has been associated previously with prostaglandin analogues. Latanoprost in particular has been reported to cause uveitis with corneal and macular edema.24 Travoprost has been a relatively recent addition to the ocular hypotensive lipid family, and since its introduction there have been relatively few reports of adverse effects. Herein we reported a case of acute anterior uveitis and clinically significant corneal edema associated with the use of travoprost. However, further studies are necessary to confirm this association.

The authors have no financial or proprietary interest in the products mentioned in this article. In addition, they received no public or private financial support pertaining to the information published in this article.

Corresponding author and reprints: William J. Faulkner, MD, Cincinnati Eye Institute, 10494 Montgomery Rd, Cincinnati, OH 45219-0777 (e-mail: wfaulkner@cincinnatieye.com).

Weisbacker  CAedFarrow  FTedFarrow  Red PR for Ophthalmic Medicines. 30th Montvale, NJ Medical Economics Co2002;
Fechtner  RDKhouri  ASZimmerman  TJ  et al.  Anterior uveitis associated with latanoprost. Am J Ophthalmol. 1998;12637- 41
PubMed
Warwar  REBullock  JDBallal  D Cystoid macular edema and anterior uveitis associated with latanoprost use: experience and incidence in a retrospective review of 94 patients. Ophthalmology. 1998;105263- 268
PubMed
Smith  SLPruitt  CASine  CSHudgins  ACStewart  WC Latanoprost 0.005% and anterior segment uveitis. Acta Ophthalmol Scand. 1999;77668- 672
PubMed

Figures

Tables

References

Weisbacker  CAedFarrow  FTedFarrow  Red PR for Ophthalmic Medicines. 30th Montvale, NJ Medical Economics Co2002;
Fechtner  RDKhouri  ASZimmerman  TJ  et al.  Anterior uveitis associated with latanoprost. Am J Ophthalmol. 1998;12637- 41
PubMed
Warwar  REBullock  JDBallal  D Cystoid macular edema and anterior uveitis associated with latanoprost use: experience and incidence in a retrospective review of 94 patients. Ophthalmology. 1998;105263- 268
PubMed
Smith  SLPruitt  CASine  CSHudgins  ACStewart  WC Latanoprost 0.005% and anterior segment uveitis. Acta Ophthalmol Scand. 1999;77668- 672
PubMed

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 8

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles