Comparison of Latanoprost/Timolol with Carbonic Anhydrase Inhibitor and Dorzolamide/Timolol with Prostaglandin Analog in the Treatment of Glaucoma

Abstract

Purpose. We retrospectively reviewed medical records of glaucoma patients to investigate how switching medications may affect intraocular pressure (IOP) management. Three concomitant medications were changed to two medications: one combination drop and one single-action drop. Associated adverse effects were also examined. Subjects and Methods. A total of 112 patients with primary open-angle glaucoma or ocular hypertension were examined. All patients were concomitantly using a prostaglandin (PG) analog, a β-blocker, and a carbonic anhydrate inhibitor (CAI). Fifty-five patients began using latanoprost (PG analog)/timolol (β-blocker) fixed-combination (LTFC) drops and a CAI (group 1), and 57 patients began using dorzolamide (CAI)/timolol fixed-combination (DTFC) drops and a PG analog (group 2). The IOP was measured every 6 months for 2 years following medication changes. Changes in visual field mean deviation (MD) and medication discontinuations were also examined. Results. There were no significant differences in IOP or MD values before and after medication changes in either group. The proportion of medication discontinuations, uncontrolled IOP, and adverse reactions was similar in both groups. Conclusion. Switching patients from multiple single-action medications to combination medications was not associated with changes in IOP, visual field testing results, or adverse event frequency.

A Study of Efficacy of Multiple Combination of Topical Anti – Glaucoma Drugs in Primary Open Angle Glaucoma

“…In 24 hour IOP measurements, Latanoprost administered once a day in the evening induces a constant IOP reduction, although the hypotensive effect seems to be greatest during the day. 10 Almost all the patients had significant glaucomatous field defects at the time of inclusion, at the end of the study no significant change was observed in fields.…”

Current management of glaucoma

“…IOP‐lowering eye drops have evolved to improve adherence rates. There are now many commercially available fixed combination eye drops, which enable two agents to be instilled with a single drop, reducing preservative load and improving convenience and thus adherence . All combination drops incorporate timolol apart from one that contains brimonidine and brinzolamide (Box 7).…”

The Intraocular Pressure-Lowering Effect of Persimmon leaves (Diospyros kaki) in a Mouse Model of Glaucoma

“…Laser trabeculoplasty and incision surgery are also alternative procedures to reduce IOP by regulating aqueous humor inflow and outflow pathways [9,10]. At present, topical prostaglandin analogs are the most widely used treatments to lower elevated IOP in patients with glaucoma and ocular hypertension, but could elicit several ocular side effects such as eyelash changes, conjunctival hyperaemia, and iris pigmentation [11,12]. If eye drops do not reduce the elevated IOP to the required level, carbonic anhydrase inhibitors can be used as oral medications, but still could pose side effects, including frequent urination, stomach upset, depression, and kidney stones [11,13].…”

“…At present, topical prostaglandin analogs are the most widely used treatments to lower elevated IOP in patients with glaucoma and ocular hypertension, but could elicit several ocular side effects such as eyelash changes, conjunctival hyperaemia, and iris pigmentation [11,12]. If eye drops do not reduce the elevated IOP to the required level, carbonic anhydrase inhibitors can be used as oral medications, but still could pose side effects, including frequent urination, stomach upset, depression, and kidney stones [11,13]. Therefore, there is an increasing demand for the development of an effective IOP-lowering agent that is easier to administer, and safe, with minimum side effects even for long-term use.…”