Topical carbonic anhydrase inhibitors and glaucoma in 2021: where do we stand?

Carbonic anhydrase inhibitors (CAIs) have been used for many decades in the treatment of glaucoma. Systemic CAIs were an early treatment option to lower intraocular pressure by reducing aqueous humour production; however, frequent side effects including polyuria and paresthesia contributed to the eventual development of topical CAIs. As topical drug development evolved over time, prostaglandin analogues and beta-blockers have become the gold standard of glaucoma therapies. Although prescribed less often than other classes of topical glaucoma therapies, topical CAIs continue to be used in combination therapies with beta-blockers and alpha agonists. Topical CAIs have also been demonstrated to alter biomarkers of ocular haemodynamics, which have relevance in glaucoma. The purpose of this review is to review and summarise the current state of topical CAI prescribing trends, known efficacy and suggested mechanisms and potential influence on ocular haemodynamics for the future of glaucoma management.

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Brimonidine as an additional treatment for moderate glaucoma

Clinical ophthalmology ◽

10.32364/2311-7729-2021-21-2-69-71 ◽

2021 ◽

Vol 21 (2) ◽

pp. 69-71

Author(s):

I.R. Gazizova ◽

◽

V.E. Korelina ◽

◽

Keyword(s):

Carbonic Anhydrase ◽

Beta Blockers ◽

Additional Treatment ◽

Carbonic Anhydrase Inhibitors ◽

Prostaglandin Analogues ◽

Group 4 ◽

Advanced Glaucoma ◽

Group 3 ◽

Group 2 ◽

Group 1

Aim: to assess the utility of brimonidine 0.2% as an additional IOP-lowering treatment for moderate glaucoma. Patients and Methods: 99 patients (121 eyes) aged 62–73 years with moderate glaucoma were enrolled. All patients were divided into four groups based on IOP-lowering medications. In group 1, prostaglandin analogues (latanoprost) and beta blockers (timolol) were prescribed. In group 2, carbonic anhydrase inhibitors (dorzolamide) and beta blockers (timolol) were prescribed. In group 3, brimonidine 0.2% was added to prostaglandin analogues and beta blockers. In group 4, brimonidine 0.2% was added to carbonic anhydrase inhibitors and beta blockers. All patients underwent IOP measurements and static automated perimetry (SAP) at baseline and after 6 and 12 months. Results: additional treatment (brimonidine) gradually reduced IOP levels in groups 3 and 4, while in groups 1 and 2 IOP levels were stable. In group 1, mean deviation (MD) increased from -10.7±4.5dB to -10.8±3.8 dB after 6 months but reduced to -10.5±3.4 dB after 12 months. In group 2, MD increased from -11.7±5.1 dB to -12.0±3.2 dB after 6 months and -12.5±2.9 dB after 12 months. In group 3, MD reduced from -13.5±4.1 dB to -12.9±3.6 dB after 6 months and -12.7±3.0 dB after 12 months. In group 4, MD reduced from -13.9±4.6 dB to -13.0±4.1 dB after 6 months and increased to -13.1±3.5 dB after 12 months. Pattern standard deviation (PSD) was stable in all four groups. Conclusion: brimonidine as an additional treatment for moderate and advanced glaucoma results in stable IOP reduction. Combined therapy which includes brimonidine preserves visual functions even in moderate-to-advanced glaucoma. The neuroprotective effect of brimonidine is illustrated by SAP. This medication is well tolerated. Keywords: glaucoma, IOP, visual field, perimetry, tonometry, neuroprotection. For citation: Gazizova I.R., Korelina V.E. Brimonidine as an additional treatment for moderate glaucoma. Russian Journal of Clinical Ophthalmology. 2021;21(2):69–71. DOI: 10.32364/2311-7729-2021-21-2-69-71.

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