Emerging treatments

Omidenepag isopropyl

Omidenepag isopropyl (a prodrug of the biologically active metabolite omidenepag) is a relatively selective prostaglandin EP2 receptor agonist with a novel mechanism of action. It reduces elevated intra-ocular pressure (IOP) by increasing aqueous humour drainage through the trabecular and uveoscleral outflow pathways. Clinical efficacy has been confirmed in several studies.[88] Approval has been granted in the US for the reduction of elevated or increased IOP in patients with open-angle glaucoma or ocular hypertension. Notable adverse effects include conjunctival hyperaemia, corneal thickening, macular oedema/cystoid macular oedema and ocular inflammation.[89] It should be used with caution in patients with aphakic or pseudophakic eyes.​​[90]

Ripasudil

Ripasudil is a rho kinase inhibitor. Efficacy of ripasudil has been demonstrated in combination with timolol or latanoprost.[61][62] Ripasudil plus timolol significantly reduced IOP compared with timolol monotherapy; combination therapy was associated with increased ocular adverse effects.[61][62] No study has compared the efficacy of ripasudil monotherapy with that of beta-blocker monotherapy.[62] Ripasudil is not currently available in the US or Europe.

Neuroprotective agents

One Cochrane review that assessed the effectiveness of neuroprotective agents in slowing the progression of open-angle glaucoma found no evidence that they prevent retinal ganglion cell death, and therefore preserve vision, in open-angle glaucoma patients.[91] Further clinical research in the form of randomised controlled trials with long-term follow-up is needed to determine efficacy.[91][92]

New drug delivery systems

Several drug delivery systems are available, or being developed, to address patient adherence and the adverse effects associated with glaucoma medical therapy. These include punctal plugs, rings placed in the fornix, drug-eluting contact lenses, subconjunctival injections/devices, intracameral delivery systems (e.g., bimatoprost and travoprost intracameral implants [approved in the US]), and drug-eluting intra-ocular devices.[93][94][95][96][97][98][99][100][101]​​​​​​​​​

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