Topically Active Carbonic Anhydrase Inhibitors for Glaucoma

Abstract

The carbonic anhydrase inhibitor, Diamox, is an effective agent in lowering intraocular pressure in man when administered in oral doses of 500 to 1000 mg. This one sentence summarized a 2½ page initial article on this subject written by a single author, Bernard Becker, in 1954. 1 A year later, Green and Leopold 2 noted that acetazolamide given subconjunctivally to rabbits did not reduce intraocular pressure. Thus began a 35-year search for an active topically administered carbonic anhydrase inhibitor, a search characterized by stops and spurts, one that is reaching fruition thanks largely to the efforts of Thomas Maren of the University of Florida. See also pp 46 and 50. Systemically administered carbonic anhydrase inhibitors, even when properly utilized in the lowest dose possible to achieve the therapeutic goal in each patient with glaucoma, produce a well-known litany of side effects, including paresthesias, gastrointestinal upset, weight loss, fatigue, depression, impotence,