Timolol + latanoprost: new preparation. Last-resort eye drops.

(1) First-line drug treatment of chronic open-angle glaucoma or intraocular hypertonia is based on monotherapy with timolol eye drops. Patients in whom several single-agent treatments have failed can use combinations of timolol + dorzolamide (a carbonic anhydrase inhibitor) or a betablocker + pilocarpine (a parasympathomimetic agent). (2) An eye-drop preparation is now available in which 0.5% timolol is combined with 0.005% latanoprost, a prostaglandin F2alpha analogue. (3) A clinical trial indicated that the timolol + latanoprost combination was more effective than the timolol + dorzolamide combination on intraocular pressure, but the report of this study is too scanty to accept these results at face value. Once-a-day dosing with timolol + latanoprost has not been compared with a betablocker + pilocarpine combination. (4) Patients using the timolol + latanoprost combination are exposed to the adverse effects of both latanoprost (especially ocular irritation and brown iris discoloration) and the betablocker. (5) It is not known whether the once-a-day dosing of the timolol + latanoprost combination is a significant advantage, especially in terms of adherence to treatment. (6) In practice, the arrival of the timolol + latanoprost combination changes virtually nothing for patients with chronic open-angle glaucoma, except for those with no other alternative.