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Carbonic anhydrase inhibitors as fourth drug in primary glaucomas: Is it worth it?

      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 (R2 = 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.

      Résumé

      Objet?>

      Évaluer l’efficacité d’inhibiteurs de l’anhydrase carbonique comme quatrième médicament dans le contrôle de la pression intraoculaire (PIO) chez des patients souffrant de glaucome primaire.

      Nature?>

      Étude prospective unicentrique.

      Participants?>

      25 yeux de 25 patients souffrant de glaucome primaire traités concomitamment avec un analogue de prostaglandine topique, un bêta-bloquant, un agoniste alpha-adrénergique et un inhibiteur de l’anhydrase carbonique.

      Méthodes?>

      Des patients suivis à la Federal University de São Paulo ont été recrutés d’août à novembre 2013 et ont d’abord subi un examen ophtalmologique où la PIO a été mesurée à 8 h, à 10 h et à 12 h. Après 15 jours de lavage avec l’inhibiteur de l’anhydrase carbonique, on a repris les mesures de la PIO.

      Résultats?>

      La plupart des patients étaient de sexe féminin et de race blanche. L’âge moyen était de 66,4 ± 9,7 ans. Le retrait du quatrième médicament a eu un effet statistiquement significatif sur la PIO de pointe (accroissement de 1,20 mmHg; p < 0,01) et sur la PIO moyenne (accroissement de 1,23 mmHg; p < 0,01), mais il n’a pas interféré significativement avec la fluctuation en avant-midi de la PIO (p = 0,83). Après l’arrêt du quatrième médicament, la PIO a augmenté de ≥2 mmHg chez 32 % des patients, et on a noté une hausse significative de la PIO (définie comme une variation de la PIO de ≥20 %) chez 5 patients (20 %) seulement. La variation documentée de la PIO était attribuable à l’âge dans environ 20 % des cas (R2= 0,19; p = 0,03).

      Conclusions?>

      Le retrait d’un quatrième médicament ne semble pas avoir un impact significatif, du point de vue clinique, sur le contrôle de la PIO chez la plupart des patients glaucomateux. Cependant, la PIO a augmenté de >2 mmHg chez 32 % des patients, et l’âge supérieur à 60 ans était le seul facteur prédicteur significatif.
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