One-Year Follow-Up Study of Changes in Prostaglandin-Associated Periorbital Syndrome After Switch From Conventional Prostaglandin F2alfa to Omidenepag Isopropyl

Abstract

Background Cosmetic problems induced by conventional prostaglandin F2α (PGF2α) analogs are common. We prospectively evaluated the improvement of patients with prostaglandin-associated periorbital syndrome (PAPS) for whom the treatment regimen was switched from conventional PGF2α analogs to a new selective prostaglandin-EP2 agonist (i.e., omidenepag isopropyl). Methods We finally evaluated 12 patients with follow-up for one year who changed the therapy from conventional PGF2α drugs to omidenepag isopropyl. Digital facial images of the patients were captured prior to the initiation of therapy with omidenepag isopropyl and after approximately three, six, and 12 months. Three independent observers judged the recovery according to the five signs of PAPS-deepening of the upper eyelid sulcus (DUES), flattening of the lower eyelid bags, upper eyelid ptosis, ciliary hypertrichosis, and periorbital skin hyperpigmentation-by comparing images at baseline and each month. Results The mean age of patients (eight females; four males) was 61 years. The original PGF2α drugs were bimatoprost (N = 7), latanoprost (N = 3), travoprost (N = 1), and tafluprost (N = 1). The mean duration of treatment with PGF2α was 61 months. PAPS signs were evaluated in 11 patients after three months and in all 12 patients after six and 12 months. After three, six, and 12 months, DUES improved in five, six, and six patients, respectively; flattening of the lower eyelid bags improved in two, two, and three patients, respectively; upper eyelid ptosis improved in zero, one, and two patients, respectively; ciliary hypertrichosis improved in zero, one, and zero patients, respectively; and eyelid pigmentation improved in one, five, and three patients, respectively. Recovery of DUES was the most observed sign at ≤50%, whereas the recovery of ciliary hypertrichosis was the least sign at ≤8% at 12 months. All patients with improved DUES at one year had been receiving bimatoprost or travoprost. Conclusions Some PAPS signs improved after the administration of omidenepag isopropyl for one year. Our findings are useful for patients suffering from cosmetic problems induced by conventional PGF2α analogs.

Omidenepag isopropyl ophthalmic solution for open-angle glaucoma and ocular hypertension: an update

“…An extension of this study, in 12 patients with PAP syndrome who were switched to omidenepag isopropyl 0.002%, found that, after 12 months, deepening of the upper eyelid sulcus improved in six patients, flattening of the lower eyelid bags improved in three, upper eyelid ptosis improved in two, and eyelid hyperpigmentation improved in three [60]. All six patients with improved deepening of the upper eyelid sulcus had been previously receiving bimatoprost or travoprost.…”

Cystoid Macular Edema Associated with Omidenepag Isopropyl in Phakic Eyes after Laser Iridotomy: A Case Report

“…Omidenepag is a selective prostaglandin EP2 receptor agonist with a nonprostaglandin structure that reduces the IOP by increasing the outflow facility and the uveoscleral outflow 5,9 . It has been previously reported that the IOP-lowering effect of omidenepag was comparable to that observed for latanoprost 0.005% in patients with OHT or POAG 5,7 .…”

“…Although prostaglandin F2α analogs (PGF2α) have been widely used as a first-line treatment for glaucoma 1 , a new antiglaucoma eye drop, omidenepag isopropyl 0.002% ophthalmic solution (omidenepag, EYBELIS®; Santen Pharmaceutical Co., Ltd., Osaka, Japan), which is a selective prostaglandin E2 receptor 2 (EP2) agonist, became available for the treatment of glaucoma and ocular hypertension (OHT) in Japan starting in 2018 [5][6][7][8][9][10] . A previous study reported that omidenepag was not inferior to latanoprost 0.005% for the reduction of IOP in patients with OHT or POAG 7 .…”

“…Moreover, omidenepag has also been shown to have few cosmetic problems such as deepening of the upper eyelid sulcus, or any increase of the iris pigmentation and eyelash changes of the so-called prostaglandin-associated periorbital syndrome, unlike that observed for PGF2α [5][6][7][8][9][10] . However, it has been reported that cystoid macular edema (CME) was a rare but serious side effect of omidenepag, similar to that seen for PGF2α.…”

Periorbital Hyperpigmentation—Dark Circles under the Eyes; Treatment Suggestions and Combining Procedures

“…Atopic dermatitis is probably the most common dermatosis associated with POH [3]. Several medical drugs may cause POH, such as prostaglandins or imatinib [4,5]. A cross-sectional study among Malaysian Chinese identified single nucleotid polymorphism in p53 and vascular endothelial growth factor A (VEGFA) genes.…”