Bimatoprost (Dyurista) for Angle Recession Glaucoma
Bimatoprost is not specifically indicated for angle recession glaucoma, though it may be used as an IOP-lowering agent in this condition based on its proven efficacy in other forms of glaucoma. 1
Efficacy of Bimatoprost in Glaucoma
- Bimatoprost 0.03% is primarily indicated for the treatment of open-angle glaucoma and ocular hypertension as a prostaglandin analogue that reduces intraocular pressure (IOP) by increasing aqueous humor outflow 2, 3
- Prostaglandin analogues (PGAs), including bimatoprost, provide the best IOP-lowering effect among all monotherapy regimens for glaucoma 1
- Bimatoprost increases mean ocular perfusion pressure when compared to timolol and may provide beneficial ocular perfusion pressure profiles compared to alternative agents 1
Evidence for Angle Recession Glaucoma
- While there is robust evidence for bimatoprost in open-angle glaucoma, the available systematic reviews do not specifically address its use in angle recession glaucoma 1
- A preliminary study demonstrated efficacy of bimatoprost 0.03% in patients with 360° synechial angle-closure glaucoma, showing statistically significant IOP reduction, suggesting potential benefit in compromised angle conditions 4
- In primary chronic angle closure glaucoma, bimatoprost 0.03% monotherapy improved ocular blood flow and provided better diurnal IOP control than concomitant timolol-pilocarpine therapy 5
Comparative Efficacy
- Bimatoprost 0.03% has demonstrated greater efficacy than timolol in providing sustained and stable reduction in IOP in long-term treatment (up to 48 months) 3
- It has shown efficacy similar to or greater than other prostaglandin analogues like latanoprost and travoprost in reducing IOP and achieving target IOP levels 3
- In patients refractory to beta-blocker therapy, bimatoprost 0.03% produced greater reductions in diurnal IOP measurements than combination therapy with topical dorzolamide 2%/timolol 0.5% 2
Safety Considerations
- The most common adverse effect of bimatoprost is conjunctival hyperemia, occurring in 32-46% of patients, though most cases are mild and only 1-4% of patients withdraw from treatment as a result 2, 5
- Other adverse events include changes in pigmentation of the periorbital skin, iris, and eyelashes, as well as eyelash growth 2, 3
- Unlike beta-blockers such as timolol, bimatoprost has not been associated with cardiopulmonary adverse effects 2
Clinical Application
- While not specifically indicated for angle recession glaucoma, bimatoprost may be considered as a treatment option based on its proven efficacy in IOP reduction across various glaucoma types 6
- The American Academy of Ophthalmology recommends prostaglandin analogues, including bimatoprost, as among the most efficacious first-line medications for lowering IOP in open-angle glaucoma and ocular hypertension 7
- For patients requiring multiple medications, fixed combination therapy of prostaglandin analogues with timolol provides better IOP-lowering effects than either component alone 7