Glaucoma therapy

Evaluate diagnostic tests (e.g., IOP, visual fields, and optic nerve evaluations) to determine if the patient s current glaucoma therapy is effective. 

Initial glaucoma therapy Instill 1 drop into the eye(s) every 12 hours. 

Instill 1 to 2 drops in the affected eye(s) 3 times daily. Because apraclonidine 0.5% will be used with other ocular glaucoma therapies, use an approximate 5-minute interval between instillation of each medication to prevent washout of the previous dose. Not for injection into the eye. 

Antiglaucoma Preparations and Miotics Sympathomimetics in glaucoma therapy (clonidine, brimonidine)... 

Currently, glaucoma therapy remains focused on mechanisms designed to decrease intraocular pressure (IOP) and this approach is considered effective also in normal tension glaucoma. 

Thromboxane A2 receptor antagonists consisting of 2-decarboxy-2-phosphinico prostaglandins (V), and prostamide derivatives, (VI), prepared by deLong (4) and Krauss (5), respectively, and were used in glaucoma therapy. 

Hsiue, G.-H., Hsu, S.-h., Yang, C.-C., Lee, S.-H., and Yang, I.-K. (2002), Preparation of controlled release ophthalmic drops, for glaucoma therapy using thermosensitive poly-iV-isopropyl acrylamide, Biomaterials, 23(2), 457-462. 

Glaucoma therapy with strong miotic agents in myopic eyes... 

Legal claims arising from glaucoma therapy may be divided into three categories adverse effects of beta-blockers, retinal detachments after initiation of miotic therapy, and complications resulting from use of CAIs. 

The ocular hypotensive effect of latanoprost appears to be independent of race, gender, age, iris color, type of glaucoma, or previous glaucoma therapy. 

Systemic effects associated with topical ocular brimonidine include dry mouth, headache, and fatigue or drowsiness. Dry mouth is generally the most common complaint, occurring in 16% to 30% of patients treated with brimonidine 0.2% twice daily. Other observed effects include decreases in systolic and diastolic blood pressure and heart rate, but these effects generally are clinically insignificant. Compared with P-blockers, brimonidine has excellent systemic tolerability and may be useful in elderly patients to improve quality of life and enhance patient satisfection with glaucoma therapy. 

In the treatment of all types of glaucoma, acetazolamide is the most widely used orally administered CAI. Acetazolamide is commercially arailable as 125- and 250-mg tablets, 500-mg sustained-release capsules (Diamox Sequels), and a 500-mg vial formulated for parenteral administration. In glaucoma therapy in adults, acetazolamide is usually administered in doses of 250 mg every 6 hours or a single 500-mg sustained-release capsule twice daily. The recommended acetazolamide dose for children is 5 to 10 mg/kg body weight, administered every 4 to 6 hours. 

The advantages of methazolamide are numerous enough that many authorities believe it should be the first CAI used for systemic glaucoma therapy. Methazolamide is commercially available in 25- and 50-mg tablets. The adult dosage is 25 to 100 mg three times daily. 

Topical dorzolamide and oral acetazolamide do not produce additive effects, and their concomitant use is not indicated for glaucoma therapy. 

Denis P, LafumaA, Khoshnood B, et al.A meta-analysis of tropical prostaglandin analogues intraocular pressure lowering in glaucoma therapy. Curr Med Res Opin 2007 23 601-608. 

Nordstrom BL, Friedman DS, Mozaffari E, et al. Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol 2005 140 598-606. 

Liesegang TJ. Conjunctival changes associated with glaucoma therapy implications for the external disease consultant and the treatment of glaucoma. Cornea 1998 17 574-583. 

The authors concluded that when a woman taking glaucoma therapy becomes pregnant, it is usually possible to interrupt therapy during pregnancy. Treatment may be deferred until delivery of the infant. 

A. Discontinue glaucoma therapy to give the patient a drug holiday. 

Tafluprost significantly increases retinal blood flow and blood velocity in animal models. The improvement of ocular blood flow is thought to be relevant in glaucoma therapy, especially for normal-tension glaucoma patients since it is assumed that optic nerve damage is involved not only in mechanical compression caused by IOPbut also in impairment of ocular blood flow. 

Agents that are neuroprotective and act through mechanisms other than lOP reduction are likely to be part of glaucoma therapy in the future. " ... 

Kooner KS. New agents in glaucoma therapy. Int Ophthalmol Clin 1999 39 1-15. 

Loon SC, Chew PT. A major review of anti metabolites in glaucoma therapy. Ophthalmologica 1999 213 234-245. 

Current pharmacotherapies are targeted to decrease the production of aqueous humor at the ciliary body and to increase outflow through the trabecular meshwork and uveoscleral pathways. There is no consensus on the best lOP-lowering technique for glaucoma therapy. General principles of patient management based on the patient s health, age, and ocular status include ... 

Pilocarpine/poly]ethylene-co-(vinyl acetate)] Ocusert , Alza Corp. Glaucoma therapy... 

Pilocarpine is a drug commonly used in glaucoma therapy to relieve intraocular pressure (lOP), which is a cause of great discomfort to the patient. Piloplex is a sustained-release product based on an emulsion system of pilocarpine bound to a polymeric carrier [87,88]. Piloplex was shown to prolong a reduction in lOP as compared to standard pilocarpine hydrochloride drops. This is attributed to its bioadhesive properties, which keep the drug in the precorneal area longer than do conventional ocular dosage forms. 

Anwar Z, Wellik SR, Galor A (2013) Glaucoma therapy and ocular surface disease current literature and recommendations. Curr Opin Ophthalmol 24 136-43... 

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