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Revista Brasileira de Oftalmologia

Print version ISSN 0034-7280On-line version ISSN 1982-8551

Rev. bras.oftalmol. vol.78 no.1 Rio de Janeiro Jan./Feb. 2019 

Original Article

Travoprosta 0,004% efficacy in intraocular pressure in patients with glaucoma

1Provisão Hospital de Olhos de Maringá, Maringá, PR, Brazil.

2Clínica de Oftalmologia Guadalupe de Cianorte, Cianorte, PR, Brazil.

3Academic Course in Medicine, Faculdade de Medicina Unicesumar, Maringá, PR,Brazil.



to evaluate how much decreases intraocular pressure (IOP) with TRAVAMED® (travoprost 0,004%) (Germed, Brazil) in patients with primary open angle glaucoma (POAG) and ocular hypertension (OH) and possible side effects.


controlled and randomized study, it was evaluated 70 eyes of 38 patients with age of 18 years old or more diagnosed with POAG and OH. All the patients had TRAVAMED® as first drop for treatment used once daily (at night) and 30 days later they had IOP measured by Goldmann tonometry, with the same examiner in the same tonometer at the same times.


the mean decrease in IOP was 7,46 mmHg after 30 days using the drops. 15.71% (11) of eyes had conjunctival redness, 8.57% (6) had pain, 8.57% (6) had burning, 2.86% (2) had blurring vision and 1.56% (1) of the eyes there wasn’t a significant reduction in IOP.


TRAVAMED® was efficient when evaluating IOP decrease. The most correlated side effects were conjunctival redness (15.71%), pain (8.57%) and burning (8.57%), but studies with longer follow-up are needed.

Keywords: Glaucoma; Ocular hypertension/drug therapy; Travoprost/adverse effects



avaliar a eficácia do colírio TRAVAMED® (travoprosta 0,004%) (Ofta, Brasil) na redução da pressão intraocular (PIO), em pacientes com glaucoma primário de ângulo aberto (GPAA) ou hipertensão ocular (HO), bem como avaliar os efeitos colaterais decorrentes do uso da droga.


estudo randomizado, controlado, com 70 olhos de 38 pacientes acima de 18 anos de idade, com diagnóstico de GPAA ou HO. Todos os pacientes receberam o colírio TRAVAMED® como primeira droga a ser introduzida no tratamento, tendo sido utilizada uma gota uma vez ao dia (à noite), e 30 dias após foram submetidos à tonometria de aplanação (Goldmann) para mensuração da PIO, com o mesmo examinador, no mesmo tonômetro e nos mesmos horários.


A média de redução da PIO após 30 dias de uso do TRAVAMED® foi de 7,46 mmHg. Em relação aos efeitos colaterais, 15,71% (11) dos olhos apresentaram hiperemia conjuntival, 8,57% (6) apresentaram dor, 8,57% (6) apresentaram ardência, 2,86% (2) apresentaram embaçamento visual e em 1,56% (1) dos olhos não houve queda significativa da PIO.


A medicação TRAVAMED® foi eficiente na redução da PIO após 30 dias de uso contínuo, na dose de 1x/dia. Acerca dos efeitos colaterais, os mais observados foram hiperemia ocular (15,71%), dor (8,57%) e ardência (8,57%), porém estudos com maior tempo de seguimento se fazem necessários.

Descritores: Glaucoma; Hipertensão ocular/tratamento farmacológico; Travoprosta/efeitos adversos


POAG is a progressive, chronic optic neuropathy characterized by typical alterations of the optic disc (OD) and the retinal nerve fiber layer (RNFL), with characteristic repercussions in the visual field (VF). Most often, it is followed by IOP measurements greater than the levels considered statistically normal. Individuals with pressure levels above 21 mmHg but without the characteristic signs of optic neuropathy are considered HO.(1) Among the hypotensive ocular medications currently available to treat POAG, prostaglandin analogs are the most potent ones, among them travoprost (0.004%), latanoposta (0.005%), and bimatoprost (0.03%).(2)

Travoprost is a selective agonist of the prostanoid receptor FP that undergoes hydrolysis by the esterases in the cornea so that the free acid is activated. Like all classes of prostaglandin analogues, its main activity is to increase the aqueous humor flow, both by trabecular and uveo-scleral pathways. The mechanisms by which this activity is achieved are not yet fully understood, but experimental studies have shown relaxation of the ciliary muscle and increased activity of extracellular matrix metalloproteinases and collagenases.(3,4)

Comparative studies have shown an equivalent or greater efficacy of travoprostol (0.004%) compared to latanoprost and timolol for IOP reduction.(5-7) And in cases of failure to control pressure with latanoprost, travoprosta showed clinically and statistically significant reduction of IOP, and may therefore be an option in these cases.(8)

Regarding adverse effects, the most related to the use of travoprost as well as to the other analogues of prostaglandins are conjunctival hyperemia, ocular irritation, pruritus, ocular pain, burning, iriana discoloration, papebral dermal hyperpigmentation of eyelids, and eyelash alterations.(3,4)

In this context, the present study aimed to evaluate the efficacy of TRAVAMED® (travoprost 0.004%) (Germed, Brazil) to reduce the IOP of patients with POAG or HO, and to evaluate the side effects of drug use..


A randomized, controlled study carried out by the Department of Glaucoma of Centro de Oftalmologia Tadeu Cvintal, São Paulo, Brazil. The sample comprised 70 eyes of 38 patients. Participants included were adult patients of either POAG or HO. All received TRAVAMED® eye drops as the first drug to be introduced in the treatment. The medication was instilled once a night in all patients, and after 30 days, they were submitted to aplanation tonometry (Goldmann) to measure the IOP by a single examiner in the same device and at the same times. In addition, participants were asked about the perception of side effects noted after the onset of eye drops. The following patients were excluded from the study: in use of topical or systemic corticosteroids, use of artificial tears, with infectious or noninfectious active conjunctivitis, keratitis, scleritis or uveitis, history of intraocular surgery prior to the introduction of medication or during the course of the study, history of inflammatory ocular diseases, progressive retinal diseases such as retinal degeneration or age-related macular disease, retinal detachment, and history of hypersensitivity to travoprostol (0.004%). The efficacy of eye drops was evaluated after 30 days of continuous use.


Statistically significant IOP variation was observed before and 30 days after continuous use of eye drops (p <0.001), as observed in table 1.

Table 1 IOP during follow-up 

IOP (mmHg) (n = 64) Evaluation before Evaluation 30 days after Variation (Post - Pre)
Average 21.14 13.68 -7.46
Median 21 13 -8
Minimum / Maximum 5 / 39 9 / 20 0 / -19
Pre x Post p < 0.001

Table 2 shows the reasons for discontinuation of treatment, whether related to eye drops intolerance or not.

Table 2 Reasons to discontinue treatment 

Variables (n = 70)
Descontinuation - n (%)
No 64 (91.43)
Yes: intolerance to eye drops (major pain and hyperemia) 06 (8.57)

The average eduction observed was 7.46 mmHg, ranging from zero to a reduction of 19 mmHg.

According to table 3, the side effects demonstrated in the eye sample were as follows: 15.71% (11) of eyes had conjunctival hyperemia, 8.57% (6) presented pain, 8.57% (6) presented ardence, 2.86% (2) presented visual blurring, and 1.56% (1) of eyes had no significant decrease in IOP.

Table 3 Side effects in the eye sample 

Efeitos colaterais - n (%) (n = 70)
No 59 (84.29)
Yes 11 (15.71)
No 64 (91.43)
Yes 06 (8.57)
Eyelash Growth
No 70 (100.0)
Yes 00 (0.00)
No 64 (91.43)
Yes 06 (8.57)
Visual blurring
No 68 (97.14)
Yes 02 (2.86)


Currently, the only factor with which we can work to avoid the progression of the POAG is in the reduction of IOP. Therefore, maintaining it at levels considered safe for the patient is crucial. Studies show that the reduction of IOP in patients with HO reduces the risk of developing glaucoma,(9,10) as well as the progression of VF loss in patients with established glaucoma.(11,12)

In the present study, an average reduction of 7.46 mmHg was observed with the use of travoprost (0.004%) 1x/day, corroborating data found in the literature.(13-17) In their study, Orengo Nania et al. found IOP reductions ranging from 5.7 to 7.2 mmHg.(18) In study carried out in the Egyptian population, Macky found an average reduction of 7.84 mmHg.(19) Gandolfi, however, found variations between 7.6 and 9.2 mmHg.(20) In a meta-analysis published in 2009, there was an average IOP reduction of 7.13 mmHg after three months of continuous use of travoprost (0.004%).(21)

Among the patients studied, 15.71% complained of conjunctival hyperemia, an incidence higher than that found by Brooks et al. (2.2%), but lower than that of Chichton (49%) and Feldman (50%).(22-24) 8,57% of the patients discontinued treatment due to intolerance to the eye drops, a higher value than that found by Brooks (5,0%) and Kumar (4,3%).(22,25) 8.57% had ocular pain or burning after instilling the eye drops, values higher than those found by Cheng (4.4 and 4.6%, respectively).(21) No pigmentary alterations or growth of eyelashes were observed, and this can be explained by the fact that the patients were followed for only one month, a time shorter than that found in the literature for observation of the effect.(26,27)


The present study led us to conclud that TRAVAMED® was efficient in reducing IOP after 30 days of continuous use at a dose of 1x/day. Regarding side effects, the most commonly observed were ocular hyperaemia, pain and burning. However, studies with a longer follow-up period are necessary.


1 Consenso Brasileiro de Glaucoma de Ângulo Aberto. Glaucoma primário de ângulo aberto/Sociedade Brasileira de Glaucoma. São Paulo: PlanMark; 2005. [ Links ]

2 Parrish RK, Palmberg P, Sheu WP; XLT Study Group. A comparison of latanoprost, bimatoprost, and travoprost in patients with elevated intraocular pressure: a 12-week, randomized, masked-evaluator multicenter study. Am J Ophthalmol. 2003;135(5):688-703. [ Links ]

3 Damji KF, Freedman S, Moroi SE, Rhee D. Shields' textbook of glaucoma. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. [ Links ]

4 Netland PA. American Academy of Ophthalmology. Glaucoma medical therapy: principles and management. 2nd ed. Oxford, New York: Oxford University Press; 2008. [ Links ]

5 Fellman RL, Sullivan EK, Ratliff M, Silver LH, Whitson JT, Turner FD, et al.; Travoprost Study Group. Comparison of travoprost 0.0015% and 0.004% with timolol 0.5% in patients with elevated intraocular pressure: a 6-month, masked, multicenter trial. Ophthalmology. 2002;109(5):998-1008. [ Links ]

6 Netland PA, Landry T, Sullivan EK, Andrew R, Silver L, Weiner A, et al.; Travoprost Study Group. Travoprost compared with latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension. Am J Ophthalmol. 2001;132(4):472-84. [ Links ]

7 Santos HD, Fernandes TA, Souza CA, Cronemberger S, Calixto N. Eficácia do latanoprosta x travoprosta avaliada pela curva diária de pressão intraocular. Arq Bras Oftalmol. 2009;72(1):13-7. [ Links ]

8 Kaback M, Geanon J, Katz G, Ripkin D, Przydryga J, Group ST; START Study Group. Ocular hypotensive efficacy of travoprost in patients unsuccessfully treated with latanoprost. Curr Med Res Opin. 2004;20(9):1341-5. [ Links ]

9 Epstein DL, Krug JH Jr, Hertzmark E, Remis LL, Edelstein DJ. A long-term clinical trial of timolol therapy versus no treatment in the management of glaucoma suspects. Ophthalmology. 1989;96(10):1460-7. [ Links ]

10 Kass MA, Gordon MO, Hoff MR, Parkinson JM, Kolker AE, Hart WM Jr, et al. Topical timolol administration reduces the incidence of glaucomatous damage in ocular hypertensive individuals. A randomized, double-masked, long-term clinical trial. Arch Ophthalmol. 1989;107(11):1590-8. [ Links ]

11 Mao LK, Stewart WC, Shields MB. Correlation between intraocular pressure control and progressive glaucomatous damage in primary open-angle glaucoma. Am J Ophthalmol. 1991;111(1):51-5. [ Links ]

12 The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol. 2000;130(4):429-40. [ Links ]

13 Alexander CL, Miller SJ, Abel SR. Prostaglandin analog treatment of glaucoma and ocular hypertension. Ann Pharmacother. 2002;36(3):504-11. [ Links ]

14 Waugh J, Jarvis B. Travoprost. Drugs Aging. 2002;19(6):465-71. [ Links ]

15 Faridi UA, Saleh TA, Ewings P, Venkateswaran M, Cadman DH, Samarasinghe RA, et al. Comparative study of three prostaglandin analogues in the treatment of newly diagnosed cases of ocular hypertension, open-angle and normal tension glaucoma. Clin Exp Ophthalmol. 2010;38(7):678-82. [ Links ]

16 Ge J, Sun XH, Wang NL, Zhao JL, Wu LL, Chen XM, et al. Intraocular pressure lowering efficacy and safety of travoprost 0.004% as a replacement therapy in patients with open angle glaucoma or ocular hypertension. Chin Med J (Engl). 2010;123(11):1417-21. [ Links ]

17 Van der Valk R, Webers CA, Lumley T, Hendrikse F, Prins MH, Schouten JS. A network meta-analysis combined direct and indirect comparisons between glaucoma drugs to rank effectiveness in lowering intraocular pressure. J Clin Epidemiol. 2009;62(12):1279-83. [ Links ]

18 Orengo-Nania S, Landry T, Von Tress M, Silver LH, Weiner A, Davis AA; Travoprost Study Group. Evaluation of travoprost as adjunctive therapy in patients with uncontrolled intraocular pressure while using timolol 0.5%. Am J Ophthalmol. 2001;132(6):860-8. [ Links ]

19 Macky TA. Bimatoprost versus travoprost in an Egyptian population: a hospital-based prospective, randomized study. J Ocul Pharmacol Ther. 2010;26(6):605-10. [ Links ]

20 Gandolfi S, Paredes T, Goldberg I, Coote M, Wells A, Volksone L, et al.; Travoprost Bak-Free Clinical Study Group. Comparison of a travoprost BAK-free formulation preserved with polyquaternium-1 with BAK-preserved travoprost in ocular hypertension or open-angle glaucoma. Eur J Ophthalmol. 2012;22(1):34-44. [ Links ]

21 Cheng JW, Xi GL, Wei RL, Cai JP, Li Y. Effects of travoprost in the treatment of open-angle glaucoma or ocular hypertension: A systematic review and meta-analysis. Curr Ther Res Clin Exp. 2009;70(4):335-50. [ Links ]

22 Brooks TC, Burlingame M, Burk M, Tortorice K, Dong D, Glassman PA, et al. Travoprost: a prostaglandin analogue for the treatment of glaucoma. Formulary Watch. 2009;44(11):322-8. [ Links ]

23 Crichton AC, Vold S, Williams JM, Hollander DA. Ocular surface tolerability of prostaglandin analogs and prostamides in patients with glaucoma or ocular hypertension. Adv Ther. 2013;30(3):260-70. [ Links ]

24 Feldman RM. Conjunctival hyperemia and the use of topical prostaglandins in glaucoma and ocular hypertension. J Ocul Pharmacol Ther. 2003;19(1):23-35. [ Links ]

25 Kumar RS, Istiantoro VW, Hoh ST, Ho CL, Oen FT, Aung T. Efficacy and safety of a systematic switch from latanoprost to travoprost in patients with glaucoma. J Glaucoma. 2007;16(7):606-9. [ Links ]

26 Inoue K, Shiokawa M, Higa R, Sugahara M, Soga T, Wakakura M, et al. Adverse periocular reactions to five types of prostaglandin analogs. Eye (Lond). 2012;26(11):1465-72. [ Links ]

27 Stjernschantz JW, Albert DM, Hu DN, Drago F, Wistrand PJ. Mechanism and clinical significance of prostaglandin-induced iris pigmentation. Surv Ophthalmol 2002; 47(1):162-75. [ Links ]

Received: August 10, 2018; Accepted: November 29, 2018

Corresponding author: Juliana Almodin Rua Silva Jardim, 359 Centro Maringá, PR, Brazil. ZIP Code 87013-010 E-mail:

The authors declare no conflicts of interests.

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