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Carbonic anhydrase inhibitors as fourth drug in primary glaucomas: Is it worth it?
Can J Ophthalmol 2015; 50(4):297-301CJ

Abstract

OBJECTIVE

To evaluate the effectiveness of carbonic anhydrase inhibitors as the fourth drug regarding intraocular pressure (IOP) control in patients with primary glaucomas.

DESIGN

Single-centre, prospective study.

PARTICIPANTS

Twenty-five eyes from 25 patients with primary glaucomas treated concomitantly with a topical prostaglandin analogue, a β-blocker, an α-adrenergic agonist, and a carbonic anhydrase inhibitor.

METHODS

Patients followed at the Federal University of São Paulo were enrolled from August to November 2013 and were initially submitted to an ophthalmologic examination where the IOP was measured at 8 am, 10 am, and 12 pm. Afterward, patients underwent a 15-day washout of the carbonic anhydrase inhibitor and had their IOP measured again.

RESULTS

Most patients were female, white, and with a mean age of 66.4 ± 9.7 years. The removal of the fourth drug had a statistically significant effect on the IOP peak (increase of 1.20 mm Hg, p < 0.01) and mean (increase of 1.23 mm Hg, p < 0.01), but it did not interfere significantly with morning fluctuation of the IOP (p = 0.83). After discontinuation of the fourth drug, the IOP increased ≥2 mm Hg in 32% of the patients, and there was a significant increase of the IOP (defined as an IOP change ≥20%) in only 5 patients (20%). Age older than 60 years was associated with 20% of the documented IOP change (R(2) = 0.19, p = 0.03).

CONCLUSIONS

The removal of a fourth medication does not appear to have a clinically significant impact on IOP control in most patients with glaucoma. However, 32% of the patients experienced an IOP increase ≥2 mm Hg, with age older than 60 years being the only significant predictive factor.

Authors+Show Affiliations

Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo.Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo.Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo.Glaucoma Service, Department of Ophthalmology, Federal University of São Paulo; Hospital Medicina dos Olhos, São Paulo, Brazil. Electronic address: tiagoprata@ig.com.br.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26257224

Citation

Juncal, Verena Ribeiro, et al. "Carbonic Anhydrase Inhibitors as Fourth Drug in Primary Glaucomas: Is It Worth It?" Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie, vol. 50, no. 4, 2015, pp. 297-301.
Juncal VR, Abdo Jorge F, Paranhos A, et al. Carbonic anhydrase inhibitors as fourth drug in primary glaucomas: Is it worth it? Can J Ophthalmol. 2015;50(4):297-301.
Juncal, V. R., Abdo Jorge, F., Paranhos, A., & Santos Prata, T. (2015). Carbonic anhydrase inhibitors as fourth drug in primary glaucomas: Is it worth it? Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie, 50(4), pp. 297-301. doi:10.1016/j.jcjo.2015.03.009.
Juncal VR, et al. Carbonic Anhydrase Inhibitors as Fourth Drug in Primary Glaucomas: Is It Worth It. Can J Ophthalmol. 2015;50(4):297-301. PubMed PMID: 26257224.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carbonic anhydrase inhibitors as fourth drug in primary glaucomas: Is it worth it? AU - Juncal,Verena Ribeiro, AU - Abdo Jorge,Felipe, AU - Paranhos,Augusto,Jr AU - Santos Prata,Tiago, PY - 2014/08/13/received PY - 2015/03/13/revised PY - 2015/03/22/accepted PY - 2015/8/11/entrez PY - 2015/8/11/pubmed PY - 2016/3/17/medline SP - 297 EP - 301 JF - Canadian journal of ophthalmology. Journal canadien d'ophtalmologie JO - Can. J. Ophthalmol. VL - 50 IS - 4 N2 - OBJECTIVE: To evaluate the effectiveness of carbonic anhydrase inhibitors as the fourth drug regarding intraocular pressure (IOP) control in patients with primary glaucomas. DESIGN: Single-centre, prospective study. PARTICIPANTS: Twenty-five eyes from 25 patients with primary glaucomas treated concomitantly with a topical prostaglandin analogue, a β-blocker, an α-adrenergic agonist, and a carbonic anhydrase inhibitor. METHODS: Patients followed at the Federal University of São Paulo were enrolled from August to November 2013 and were initially submitted to an ophthalmologic examination where the IOP was measured at 8 am, 10 am, and 12 pm. Afterward, patients underwent a 15-day washout of the carbonic anhydrase inhibitor and had their IOP measured again. RESULTS: Most patients were female, white, and with a mean age of 66.4 ± 9.7 years. The removal of the fourth drug had a statistically significant effect on the IOP peak (increase of 1.20 mm Hg, p < 0.01) and mean (increase of 1.23 mm Hg, p < 0.01), but it did not interfere significantly with morning fluctuation of the IOP (p = 0.83). After discontinuation of the fourth drug, the IOP increased ≥2 mm Hg in 32% of the patients, and there was a significant increase of the IOP (defined as an IOP change ≥20%) in only 5 patients (20%). Age older than 60 years was associated with 20% of the documented IOP change (R(2) = 0.19, p = 0.03). CONCLUSIONS: The removal of a fourth medication does not appear to have a clinically significant impact on IOP control in most patients with glaucoma. However, 32% of the patients experienced an IOP increase ≥2 mm Hg, with age older than 60 years being the only significant predictive factor. SN - 1715-3360 UR - https://www.unboundmedicine.com/medline/citation/26257224/Carbonic_anhydrase_inhibitors_as_fourth_drug_in_primary_glaucomas:_Is_it_worth_it L2 - https://linkinghub.elsevier.com/retrieve/pii/S0008-4182(15)00155-6 DB - PRIME DP - Unbound Medicine ER -