Oral versus topical carbonic anhydrase inhibitors in ocular hypertension after scleral tunnel cataract surgery

Abstract

Purpose:To compare the effect of oral acetazolamide and topical 2% dorzolamide in prevention of ocular hypertension after scleral tunnel cataract surgery.Setting:Ophthalmic department, Sana’a University, Yemen Sana’a from March 2007 to October 2007.Methods:This prospective double-blind, randomized study included 150 eyes undergoing scleral tunnel cataract surgery with hard posterior chamber intraocular implantation. Methylcellulose was used as the viscoelastic in all surgery cases. Patients were assigned to one of three groups: group 1: topical gentamicin eye drops (control; n = 52); group 2: systemic acetazolamide 250 mg (n = 45); and group 3: topical 2% dorzolamide (n = 53). Acetazolamide patients received one 250 mg tablet, one hour before surgery, then half a tablet every eight hours. A topical dorzolamide 2% or gentamicin was applied in one drop one hour before surgery then every eight hours, for three days postoperatively. Intraocular pressures (IOP) were measured by Goldman applanation tonometry one hour preoperatively and 16, 24, and 48 hours postoperatively.Results:At 16 hours, IOP between the three groups increased significantly with a statistically significant p-value of 0.008, but the mean IOP of acetazolamide patients was less than other groups. IOP nearly returned to the normal level 24 and 48 hours postoperatively, but this was not statistically significant (p = 0.452 and 0.138, respectively).Conclusion:Acetazolamide offers better IOP control than topical dorzolamide 2% in preventing ocular hypertension after scleral tunnel cataract surgery.

Brinzolamide‐timolol fixed combination for the prevention of intraocular pressure elevation after phacoemulsification

“…In fact, Byrd and Singh 16 recommended the administration of 500-mg acetazolamide 1 h preoperatively to control post-cataract IOP elevation. Although it is effective in lowering postoperative IOP, 6,8,15,16,19 acetazolamide should be administered with caution in elderly patients with systemic diseases, which constitute the majority of cataract patients, because of its potentially fatal adverse events like acid-base disturbance, hepatic insufficiency, hypersensitivity reactions, aplastic anaemia and other blood dyscrasias. [27][28][29][30] Based on this premise, many surgeons choose to instil topical antiglaucoma agents instead of systemic carbonic anhydrase inhibitors.…”

“…Based on the earlier data, many surgeons use ocular topical or systemic hypotensive drugs prophylactically before or after cataract surgery to minimize any IOP spikes, albeit there are no specific guidelines. Several studies have been conducted in order to evaluate the efficacy of a variety of antiglaucoma agents on IOP after phacoemulsification . Recently, a brinzolamide‐timolol fixed combination (Azarga, Alcon Pharma GmbH, Puurs, Belgium) has become commercially available and has been approved in the European Union for the treatment of primary open‐angle glaucoma or ocular hypertension.…”

“…Several studies have been conducted in order to evaluate the efficacy of a variety of antiglaucoma agents on IOP after phacoemulsification. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Recently, a brinzolamide-timolol fixed combination (Azarga, Alcon Pharma GmbH, Puurs, Belgium) has become commercially available and has been approved in the European Union for the treatment of primary openangle glaucoma or ocular hypertension. It consists of brinzolamide 1%, which is a carbonic anhydrase inhibitor and timolol 0.5%, a b-adrenergic receptor blocker.…”

Comparison of Efficacy and Safety of Topical Dorzolamide-Timolol Maleate Combination with Oral Acetazolamide for Prevention of Intraocular Pressure Rise Following Phacoemulsification Surgery

“…Additionally, it may cause non-arteritic anterior ischaemic optic neuropathy, central retinal arterial or vein occlusion in susceptible patients. 1,6 Different agents like intracameral carbachol and acethylcholine, pilocarpine, beta-blockers, prostaglandin analoges, oral or topical carbonic anhydrase enzyme inhibitors may be used to prevent postoperative IOP spikes. [6][7][8][9] In this study, we compared the efficacy and safety of topical dorzolamide-timolol maleate combination with oral acetazolamide for prevention of intraocular pressure rise following phacoemulsification surgery.…”

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

“…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.…”