Acetazolamide and
pilocarpine have a central role in the initial management of primary acute
angle closure glaucoma (PACG), but there is no consensus concerning their mode of delivery, as borne out by a recent survey of senior UK ophthalmologists reported below.
Ocusert Pilo 40 was developed to remain in situ releasing
pilocarpine for up to one week. In view of its potential advantages, a trial of
Ocusert Pilo 40's efficacy in PACG was conducted. In two separate controlled studies, eyes diagnosed with PACG were randomised to receive
Ocusert Pilo 40, and either an intensive
pilocarpine regimen or a low-dose
pilocarpine treatment. All patients also received
Diamox 500 mg i.v. Two hours after starting topical treatment, the study was terminated and ocular and systemic response to treatment and the eventual outcome were assessed. In both studies, intravenous
Diamox caused a fall of intraocular pressure (IOP) within 30 min. Over the treatment period, a comparable reduction in IOP was seen in the
Ocusert-treated, the intensive-
pilocarpine-treated, and the low-dose-
pilocarpine-treated groups. No damage to the corneas were observed.