Latanoprost 50micrograms/ml eye drops

ObjectiveTo evaluate and compare the effectiveness and safety of latanoprost, bimatoprost, travoprost, and tafluprost in lowering intraocular pressure (IOP) in individuals with glaucoma or ocular hypertension.MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) published up to April 2025 comparing latanoprost, bimatoprost, travoprost, and tafluprost in adults with glaucoma or ocular hypertension. Primary outcomes were IOP reduction and conjunctival hyperemia. We assessed study quality using the Cochrane Risk of Bias 2.0 tool. Evidence certainty was evaluated with the CINeMA framework. A Bayesian network meta-analysis was conducted in RStudio. This review is registered with PROSPERO (CRD420251034803).Results25 RCTs published between 2001 and 2024, involving 4,045 participants, were included. All studies compared monotherapy with latanoprost, bimatoprost, travoprost, or tafluprost. Among these, bimatoprost showed the most effective reduction in intraocular pressure compared to latanoprost [mean difference (MD) 0.69; 95%confidence interval (CI) 0.28-1.1; SUCRA 95.6%; moderate confidence]. It also performed significantly better than travoprost (MD 0.64; 0.14-1.09; 39.2%; low confidence). No other comparisons showed statistically significant differences. Overall, the quality of evidence for this outcome ranged from low to moderate. In terms of safety, 16 trials, including 3,119 participants, reported on conjunctival hyperemia. Both bimatoprost [odds ratio (OR) 3.3; 2.5-4.5; 18.4%, high confidence] and travoprost (0.46; 0.33-0.63; 55%, high confidence) were associated with a higher risk of hyperemia compared to latanoprost. Bimatoprost also posed a significantly greater risk than travoprost (1.51; 1.06-2.16, high confidence).ConclusionBimatoprost provided the greatest IOP reduction but carried a higher risk of conjunctival hyperemia. Latanoprost and tafluprost offered balanced efficacy with better tolerability, making them suitable for patients with mild disease.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251034803.

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This study systematically evaluates the efficacy, safety, tolerability, and contemporary clinical positioning of topical pilocarpine in the management of glaucoma and ocular hypertension. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed/MEDLINE, EMBASE, Cochrane CENTRAL via the Cochrane Library, Scopus, Web of Science Core Collection, and Google Scholar were searched from inception to 1 May 2026 without language restrictions. Randomized controlled trials and controlled observational studies in adults with glaucoma or ocular hypertension were eligible when topical pilocarpine, used alone or in combination, was compared with placebo, no treatment, laser trabeculoplasty, or other intraocular pressure (IOP)-lowering therapies. The primary outcome was mean change in IOP, and secondary outcomes included responder outcomes, ocular adverse events, discontinuation, visual field outcomes, medication burden, post-laser pressure spikes, and postoperative outcomes. Risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool (RoB 2.0) for randomized studies and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool for nonrandomized studies. We performed random-effects meta-analysis using raw mean difference in mmHg for continuous outcomes and risk ratio (RR) for binary safety outcomes, each reported with a 95% confidence interval (CI); certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Of the 38 studies that met the inclusion criteria, 34 contributed data to the quantitative meta-analysis. In the primary analysis, pilocarpine-containing regimens reduced IOP by an additional 1.16 mmHg compared to all comparators (95% CI 0.84 to 1.47; P 2 = 50.7%). Subgroup analyses suggested larger pooled effects in placebo/no-treatment comparisons, ocular hypertension, primary open-angle glaucoma, and monotherapy studies; however, comparisons with beta-blockers and prostaglandin analogs require cautious interpretation because several large individual trials favored timolol or latanoprost for daily clinical use, tolerability, or dosing convenience. Pilocarpine was associated with a sevenfold higher risk of blurred vision (RR 7.33; 95% CI 3.30 to 16.29) and a sixfold higher risk of discontinuation due to adverse events (RR 6.07; 95% CI 3.69 to 10.00). Egger's test pointed to funnel plot asymmetry (P = 0.003), although the trim and fill method did not impute any missing studies. Pilocarpine lowers IOP effectively, but its modern role is limited by frequent dosing, miosis, blurred vision, accommodative symptoms, brow ache, and higher discontinuation. In current glaucoma care, prostaglandin analogs and selective laser trabeculoplasty are generally more consistent with first-line open-angle glaucoma management, whereas pilocarpine is better positioned for selected clinical scenarios, including angle-closure mechanisms, post-laser pressure-spike prophylaxis, selected postoperative angle-surgery settings, intolerance or nonresponse to other drug classes, and resource-limited settings where newer therapies are unavailable or unaffordable.

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