Omidenepag Isopropyl Drops Lower IOP, Risk Corneal Erosion

For patients with normal tension glaucoma (NTG), 0.002% omidenepag isopropyl (OMDI) drops can stabilize intraocular pressure (IOP) in 6 months, but the treatment is also associated with corneal thickening and erosion, according to findings published in the Journal of Glaucoma.

Researchers reviewed records of 62 patients (mean age, 59.0±13.4 years; 60% women; mean IOP, 13.4±3.8 mm Hg) between 2021 and 2022. The study cohort also had a mean central corneal thickness (CCT) of 531.5±27.6 μm, Oxford grade of corneal erosion of 0.4±0.9, and corrected distance visual acuity of 0.1±0.1 logMAR at baseline. All patients received 0.002% OMDI drops for more than 6 months to treat open angle glaucoma and were evaluated on specular microscope.

Most patients were using OMDI as an alternative to a previous treatment (n=43) rather than as an additive treatment (n=13) or first-line treatment (n=6).

Compared with baseline, IOP decreased significantly by month 1 (mean, 11.9 mm Hg; P =.001) and was sustained through months 3 (mean, 11.7 mm Hg; P =.001) and 6 (mean, 12.2 mm Hg; P =.004). The subset of patients who used OMDI as an additive treatment were associated with a greater decrease in IOP from baseline than the patients who switched to OMDI from other therapies (mean difference [MD], -1.8 vs -0.8 mm Hg), respectively.

At 6 months CCT had significantly increased (mean, 539.9 μm; P =.009) as did corneal erosion (mean, 1.3; P <.001) compared with baseline.

The most common adverse events included corneal erosion (27.4%), corneal thickening (21.0%), and conjunctival hyperemia (11.3%). Some patients also reported subjective symptoms of photophobia (5.7%), blurred vision (5.7%), and eye pain (1.6%).

The major limitation of this study was that the microscope used for eye exam was an older model that could only evaluate hexagonality of endothelial cells in a small area in the center of the cornea.

The study authors report that OMDI 0.002% drops exhibit “significant and stable” IOP reductions for 6 months in NTG patients with a mean baseline IOP of 13.4 ± 3.8 mm Hg. “Concomitant use of OMDI with timolol-containing fixed combination drugs showed additive IOP reductions,” according to the researchers. “However, transient myopic and corneal endothelial cell changes, development of corneal thickening, and corneal erosion should be considered when using OMDI. Prostaglandin-associated periorbitopathy and most drug-related adverse effects were mild and infrequent.”