ABSTRACT

Bimatoprost ‘face-to-face’ in comparison with PGF2a isopropyl esther raised fierce debate. Four randomized multicenter prospective clinical trials are so far available. In no case was bimatoprost reported as less effective than PGF2a isopropyl esther. One trial showed comparable efficacy of both drugs on IOP.17 Two trials showed some improved efficacy of bimatoprost at selected time points on the daily curve.7,18 The fourth, among those trials directly comparing bimatoprost with PGF2a isopropyl esther, showed bimatoprost to be more effective at every time point on the daily curve.10 Interestingly, a short course of bimatoprost 0.03% once daily can significantly decrease IOP in normal subjects.19 Taken together, the results of these trials show that bimatoprost is likely to offer ‘at least’ the same efficacy profile, if not better, than PGF2a isopropyl esther; therefore, bimatoprost can be offered as a potentially successful option in normal-tension glaucoma.

Prostaglandin derivatives are potent IOP-reducing agents. However, a significant number of patients can show poor response upon treatment with PGF2a isopropyl esther eyedrops. The actual prevalence of non-responders to prostaglandins among the glaucoma population is still a matter of debate.The reported numbers can greatly vary according to (a) the treatment schedule (i.e. monotherapy or multitherapy), and to (b) the more-orless conservative definition of non-responder.Therefore, the measured prevalence of nonreponders can range from 4 to 50% of the studied patients.20-25 Dealing with patients who show a poor response to PGF2a isopropyl esther may then be rather difficult.