Therapy For Open-angle Glaucoma Research Articles

Effects of aminotetralins on intraocular pressure and pupillary function in rabbits.

Aminotetralin compounds, A-6, 7-DTN and TL-99, produced bisphasic changes in intraocular pressure (IOP) and pupillary dilatation in rabbits. The rise in IOP appeared to result from an action on extraocular muscles because this effect was not produced by either compound in rabbits with transected extraocular muscles. The ocular hypotensive action of A-6, 7-DTN and TL-99 was markedly attenuated in sympathectomized rabbits indicating that this action resulted from suppression of sympathetic neuronal activity. Inhibition of ocular hypertension induced by waterloading by both compounds and suppression of the IOP recovery rate by A-6, 7-DTN suggested that the latter compound lowered IOP, in part, by inhibiting aqueous humor formation. The ocular hypotensive action of A-6, 7-DTN was antagonized by pretreatment with sulpiride, but not by yohimbine, indicating that dopamine receptors are involved in the response. These studies demonstrated that dopamine agonists can lower IOP and suggest that these types of drugs might prove useful in the therapy of open-angle glaucoma.

Laser trabeculoplasty as primary therapy in chronic open angle glaucoma.

Sixty-three phakic eyes of 54 patients with early simple (21 eyes) or capsular (42 eyes) glaucoma treated with laser trabeculoplasty (LTP) as the primary therapy were followed retrospectively 12 to 18 months after LTP. In 59 of 63 eyes followed up for 12 months and 46 of 52 eyes followed up for 18 months the intraocular pressure (IOP) was constantly maintained below 22 mmHg with no medication. After a good initial response for 6 to 12 months, 6 eyes required medical therapy because of uncontrolled pressure or progression in the damage of the optic disc or visual fields. The mean pressure reduction of all eyes 18 months after LTP was 28% in simple and 37% in capsular glaucoma. No severe complications were seen. LTP seems to be an effective and safe procedure as the primary therapy for open angle glaucoma.

Combined timolol and epinephrine therapy for open angle glaucoma

A survey of the literature concerning the interaction of timolol and epinephrine in lowering intraocular pressure, and a study comparing the efficacy of timolol and dipivefrin (a prodrug of epinephrine) to that of timolol and pilocarpine are presented. These observations suggest that timolol-epinephrine therapy is less effective than timolol-pilocarpine treatment, although the former combination has clinical value in some patients, and it is possible that this can be enhanced when special schedules for drug administration are used.

Visual field survival: the response to timolol therapy in open-angle glaucoma.

A simple method for quantifying visual field survival was devised to assess the progress of chronic simple glaucoma in 36 patients treated with timolol maleate over a 3-year period. Routine tonometric monitoring of the intraocular pressure (IOP) was carried out in conjunction with these Goldmann field studies. Statistical analysis revealed that field survival measurement provided a more consistent clinical guide to the progress of glaucoma under treatment than did IOP (p much less than 0.001). Timolol therapy was associated with sustained IOP reductions of 24.3-34.5%, and 63% of those treated who were monitored for field survival showed no significant field loss. The observed relationships of IOP to field survival are discussed.

Laser Therapy for Open Angle Glaucoma

Fort-five phakic eyes with open angle glaucoma received argon laser therapy to the trabecular meshwork (laser goniotherapy). The average IOP dropped from 27.5 to 20.3 mm Hg in 22 eyes that were followed up for seven to fourteen months. Tonographic data obtained from 13 eyes prior to and approximately one month after laser treatment demonstrated a 50% increase in the facility of aqueous outflow. Several eyes experienced hypertensive episodes following treatment, in which the IOP increased as high as 60 mm Hg on one occasion. Two eyes developed prolonged uveitis with peripheral anterior synechiae formation. Laser goniotherapy appears to be a beneficial mode of therapy for open angle glaucoma in many patients. Longer follow-up is needed, however, and its role in secondary and aphakic glaucomas needs to be defined.

Timolol in the therapy of “ocular hypertension”

Timolol has been shown to be at least as effective as pilocarpine and epinephrine in the therapy of open angle glaucoma. To date there appear to have been few serious side effects from timolol when it has been used in patients without cardiac or pulmonary disease. The decision whether and when to treat a patient with elevated intraocular pressure depends upon a weighing of risk of glaucoma damage versus the side effects of the drugs used in therapy. The use of the beta blocking agents, particularly timolol, in the therapy of ocular hypertension is considered. Reports on the efficacy and safety of timolol are cited, and the authors' reevaluation of their own series of patients treated with timolol for 17–36 months is discussed.

Timolol in the Treatment of Open Angle Glaucoma

Timolol maleate is the first beta-adrenergic-blocking drug available in the United States for topical therapy in open angle glaucoma. It may be used alone for initial therapy in selected patients or with other antiglaucoma drugs in patients requiring additional control. It should be tried, before resorting to surgery, when traditional maximal medical therapy has failed or is not tolerated. Timolol has few local side effects, but since it is absorbed, it may produce systemic reactions similar to those induced by orally administered propranolol hydrochloride. Timolol appears to be an important advance in antiglaucoma therapy, although further experience is needed to determine whether its long-term usefulness will be limited by the development of tolerance or the appearance of unexpected side effects.

Clinical Trial Comparing Timolol Ophthalmic Solution to Pilocarpine in Open-Angle Glaucoma

A ten-week, double-masked, randomized, clinical trial compared timolol ophthalmic solution and pilocarpine in the therapy of open-angle glaucoma. Timolol decreased the intraocular pressure at least as much as pilocarpine and did not induce miosis, accommodative spasm, or other annoying side effects. The pulse was slowed by timolol, but blood pressure was unaffected. Significant decreases in intraocular pressure were still present after ten weeks of maintenance therapy with the same concentration of drug.

Symposium on Ocular Therapy,

This monograph contains the papers presented at the drug symposium held by the American Academy of Ophthalmology and Otolaryngology together with the Association for Research in Vision and Ophthalmology in Dallas, 1974. All ten papers are of interest to the practicing ophthalmologist. Some of the papers summarize in an excellent and concise form the present state of the arts and certain aspects of ocular therapeutics. In this category fall the papers on local anesthetics by P. P. Ellis, treatment of viral infections by H. Kaufman, and management of bacterial corneal ulcers by T. Pettit. Other papers summarize modern aspects of ocular therapy in a scientific and most sophisticated manner, such as the review on adrenergic therapy of open angle glaucoma by Marvin Sears. A few of the papers report on new findings or the results of new and unusual treatments, such as the contribution on immunosuppressive therapy by Robert Burns

Low-Concentration Phospholine Iodide therapy in Open-Angle Glaucoma : A comparison with other medical therapies

Low-Concentration Phospholine Iodide therapy in Open-Angle Glaucoma : A comparison with other medical therapies