Phacomorphic Glaucoma Medication
- Author: Harpreet Gill, MD; Chief Editor: Hampton Roy Sr, MD more...
Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Carbonic anhydrase inhibitors
Class Summary
Carbonic anhydrase is an enzyme found in many tissues of the body, including the eye. Catalyzes a reversible reaction where carbon dioxide becomes hydrated and carbonic acid becomes dehydrated. By slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport, it may inhibit carbonic anhydrase in the ciliary processes of the eye. This effect decreases aqueous humor secretion, reducing IOP.
Acetazolamide (Diamox, Diamox Sequels)
Inhibits enzyme carbonic anhydrase, reducing the rate of aqueous humor formation, which, in turn, reduces IOP.
Dorzolamide (Trusopt)
Used concomitantly with other topical ophthalmic drug products to lower IOP. If more than one ophthalmic drug is being used, administer the drugs at least 10 min apart. Reversibly inhibits carbonic anhydrase, reducing hydrogen ion secretion at renal tubule and increasing renal excretion of sodium, potassium bicarbonate, and water to decrease production of aqueous humor.
Alpha-adrenergic agonists
Class Summary
Decrease IOP, possibly by reducing aqueous humor production.
Apraclonidine (Iopidine)
Reduces elevated and normal IOP whether or not accompanied by glaucoma. Apraclonidine is a relatively selective alpha-adrenergic agonist that does not have significant local anesthetic activity. Has minimal cardiovascular effects.
Hyperosmotic agents
Class Summary
Lower IOP by creating an osmotic gradient between ocular fluids and plasma. They are not for long-term use.
Isosorbide dinitrate (Ismotic)
May be used to abort an acute attack of glaucoma. In the eyes, may create an osmotic gradient between plasma and ocular fluids and induce diuresis by elevating osmolarity of glomerular filtrate. These effects may inhibit tubular reabsorption of water. Treatment preferred when less risk of nausea and vomiting than that posed by other oral hyperosmotic agents is desired.
Mannitol (Osmitrol, Resectisol)
Reduces elevated IOP when the pressure cannot be lowered by other means. Initially assess for adequate renal function in adults by administering a test dose of 200 mg/kg, given IV over 3-5 min. Should produce a urine flow of at least 30-50 mL/h over 2-3 h. In children, assess for adequate renal function by administering a test dose of 200 mg/kg, given IV over 3-5 min. Should produce a urine flow of at least 1 mL/h over 1-3 h.
Prostaglandins
Class Summary
Decrease IOP, possibly by increasing outflow of aqueous humor.
Bimatoprost ophthalmic solution (Lumigan)
Prostaglandin agonist that selectively mimics effects of naturally occurring substances, prostamides. Exact mechanism of action unknown but believed to reduce IOP by increasing outflow of aqueous humor through trabecular meshwork and uveoscleral routes.
Travoprost ophthalmic solution (Travatan)
Prostaglandin F2-alpha analog and selective FP prostanoid receptor agonist. Exact mechanism of action unknown but believed to reduce IOP by increasing uveoscleral outflow.
Latanoprost (Xalatan)
May decrease IOP by increasing outflow of aqueous humor.
Beta-blockers
Class Summary
Decrease aqueous humor production.
Levobunolol (AKBeta, Betagan)
Nonselective beta-adrenergic blocking agent that lowers IOP by reducing aqueous humor production.
Timolol ophthalmic (Timoptic, Timoptic XE)
May reduce elevated and normal IOP, with or without glaucoma, by reducing production of aqueous humor or by outflow.
Antiglaucoma, Combos
Class Summary
Antiglaucoma combination agents. Beta-blocker with alpha agonist.
Brimonidine/timolol (Combigan)
Selective alpha-2 adrenergic receptor agonist with a nonselective beta-adrenergic receptor inhibitor. Each of them decrease elevated IOP, whether or not associated with glaucoma damage.
Tham CC, Lai JS, Poon AS, Chan JC, Lam SW, Chua JK, et al. Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study. Eye (Lond). Jul 2005;19(7):778-83. [Medline].
Leung CK, Chan WM, Ko CY, Chui SI, Woo J, Tsang MK, et al. Visualization of anterior chamber angle dynamics using optical coherence tomography. Ophthalmology. Jun 2005;112(6):980-4. [Medline].
Dada T, Kumar S, Gadia R, Aggarwal A, Gupta V, Sihota R. Sutureless single-port transconjunctival pars plana limited vitrectomy combined with phacoemulsification for management of phacomorphic glaucoma. J Cataract Refract Surg. Jun 2007;33(6):951-4. [Medline].
Albert DM, Jakobiec FA. Principles and Practice of Ophthalmology. Vol 3. 1994.
Duane TD, Jaeger EA. Clinical Ophthalmology. Vol 3. 1986.
McKibbin M, Gupta A, Atkins AD. Cataract extraction and intraocular lens implantation in eyes with phacomorphic or phacolytic glaucoma. J Cataract Refract Surg. Jun 1996;22(5):633-6. [Medline].
Rao SK, Padmanabhan P. Capsulorhexis in white cataracts. J Cataract Refract Surg. Apr 2000;26(4):477-8. [Medline].
Ritch R, Shields MB, Krupin T. The Glaucomas. Vol 2. 1996.
Shields MB. Textbook of Glaucoma. 1998.
Vander JF, Gault JA. Ophthalmology Secrets. 1998.
Print
