Carbonic anhydrase inhibitors as fourth drug in primary glaucomas: Is it worth it?

Abstract

OBJECTIVE:

To evaluate the effectiveness of carbonic anhydrase inhibitors as the fourth drug regarding intraocular pressure (IOP) control in patients with primary glaucomas.

DESIGN:

Single-centre, prospective study.

PARTICIPANTS:

Twenty-five eyes from 25 patients with primary glaucomas treated concomitantly with a topical prostaglandin analogue, a β-blocker, an α-adrenergic agonist, and a carbonic anhydrase inhibitor.

METHODS:

Patients followed at the Federal University of São Paulo were enrolled from August to November 2013 and were initially submitted to an ophthalmologic examination where the IOP was measured at 8 am, 10 am, and 12 pm. Afterward, patients underwent a 15-day washout of the carbonic anhydrase inhibitor and had their IOP measured again.

RESULTS:

Most patients were female, white, and with a mean age of 66.4 ± 9.7 years. The removal of the fourth drug had a statistically significant effect on the IOP peak (increase of 1.20 mm Hg, p < 0.01) and mean (increase of 1.23 mm Hg, p < 0.01), but it did not interfere significantly with morning fluctuation of the IOP (p = 0.83). After discontinuation of the fourth drug, the IOP increased ≥2 mm Hg in 32% of the patients, and there was a significant increase of the IOP (defined as an IOP change ≥20%) in only 5 patients (20%). Age older than 60 years was associated with 20% of the documented IOP change (R(2) = 0.19, p = 0.03).

CONCLUSIONS:

The removal of a fourth medication does not appear to have a clinically significant impact on IOP control in most patients with glaucoma. However, 32% of the patients experienced an IOP increase ≥2 mm Hg, with age older than 60 years being the only significant predictive factor.

• Authors: Verena Ribeiro Juncal, Felipe Abdo Jorge, Augusto Paranhos Jr, Tiago Santos Prata
• Journal: Canadian journal of ophthalmology. Journal canadien d'ophtalmologie (Can J Ophthalmol) Vol. 50 Issue 4 Pg. 297-301 (Aug 2015) ISSN: 1715-3360 [Electronic] England
• PMID: 26257224 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Adrenergic alpha-Agonists
• Adrenergic beta-Antagonists
• Antihypertensive Agents
• Carbonic Anhydrase Inhibitors
• Ophthalmic Solutions
• Prostaglandins, Synthetic

Topics

• Adrenergic alpha-Agonists (therapeutic use)
• Adrenergic beta-Antagonists (therapeutic use)
• Aged
• Antihypertensive Agents (therapeutic use)
• Carbonic Anhydrase Inhibitors (therapeutic use)
• Drug Therapy, Combination
• Female
• Glaucoma (drug therapy, physiopathology)
• Glaucoma, Angle-Closure (drug therapy, physiopathology)
• Glaucoma, Open-Angle (drug therapy, physiopathology)
• Humans
• Intraocular Pressure (drug effects)
• Male
• Middle Aged
• Ophthalmic Solutions
• Prospective Studies
• Prostaglandins, Synthetic (therapeutic use)
• Tonometry, Ocular