Purpose: Matrix metalloproteinases (MMPs) are a family of enzymes that act to degrade extracellular
matrix (ECM) molecules, such as collagen, elastin, and gelatin. The glaucoma medication
latanoprost, and possibly other topical prostaglandin analogs, increase uveoscleral outflow
and lower intraocular pressure (IOP) in primary open-angle glaucoma (POAG) by
activating MMPs 1, 2, 3, and 9 in the ciliary body. It has been reported that latanoprost may
also gain access to the posterior segment and induce cystoid macular edema, although the
mechanism is unknown. In the choroid, activation of some of the same subtypes of MMPs
(particularly subtypes 2 and 9) has been implicated in the formation of choroidal neovascular
membranes (CNVMs) in age-related macular degeneration (AMD). This study examined
whether topical prostaglandin analog use is associated with a greater risk of CNVM formation
in patients diagnosed with both AMD and POAG.
Methods: A retrospective record review was performed to identify patients with a concurrent
diagnosis of AMD and POAG between 1998 and 2004. Four hundred and eighty-four
(484) eyes were identified and grouped as wet (n = 65) or dry (n = 419) AMD. Prostaglandin
usage was compared between the two groups. Usage of other glaucoma medications was also
compared. A minimum of 1 year of topical glaucoma medication was required for inclusion
in the study. Exclusion criteria included a history of CNVM prior to starting glaucoma medications
and a previous history of glaucoma surgery.
Results: Fifty-six percent (56%) of dry AMD and 62% of wet AMD eyes were using a topical
prostaglandin (P > 0.10; not significant). Analysis of specific topical prostaglandin analog
usage in the wet versus dry AMD groups revealed no statistically significant differences in
the percentage of eyes treated with latanoprost (37.7% versus 41.5%), bimatoprost (12.9% versus
10.8%), or travoprost (9.2% versus 5.3%), respectively. No significant differences in the
use of other glaucoma medications were observed between the two groups.
Conclusions: No association between long-term topical prostaglandin use and CNVM development
was found in patients with AMD and POAG.
