Related Experiment Videos
Topical versus oral carbonic anhydrase inhibitor therapy for pediatric glaucoma
M Portellos1, E G Buckley, S F Freedman
1Duke University Eye Center, Durham, North Carolina 27710, USA.
Insights
Oral acetazolamide significantly reduced intraocular pressure (IOP) more than topical dorzolamide in pediatric glaucoma patients. While dorzolamide lowered IOP, it was less effective than acetazolamide for managing pediatric glaucoma.
Area of Science:
- Ophthalmology
- Pediatric Glaucoma Management
- Pharmacological Interventions
Background:
- Pediatric glaucoma requires effective intraocular pressure (IOP) management.
- Carbonic anhydrase inhibitors (CAIs) are used to lower IOP.
- Comparing oral acetazolamide and topical dorzolamide offers insights into treatment efficacy.
Purpose of the Study:
- To compare the hypotensive effect of oral acetazolamide versus topical dorzolamide in pediatric glaucoma patients.
- To evaluate the efficacy of these CAIs in a crossover design.
Main Methods:
- Retrospective review of pediatric patients (<18 years) switched from acetazolamide to dorzolamide.
- Intraocular pressures measured using Tono-Pen or applanation tonometer.
- Analysis of IOP changes and treatment outcomes over specified follow-up periods.
Main Results:
- Oral acetazolamide reduced IOP by 35.7%, while topical dorzolamide reduced IOP by 27.4%.
- Switching from acetazolamide to dorzolamide resulted in a mean IOP increase of 20.2%.
- Five patients required additional treatment, and one was switched back to acetazolamide for better IOP control.
Conclusions:
- Topical dorzolamide provides significant IOP reduction in pediatric glaucoma patients.
- Oral acetazolamide demonstrates greater efficacy in lowering IOP compared to topical dorzolamide.
- Dorzolamide is generally well-tolerated but may be less effective for some pediatric glaucoma cases.
Purpose:
Our purpose was to compare, in a crossover design,the hypotensive effect of oral acetazolamide (Diamox) and topical dorzolamide (Trusopt) in patients with pediatric glaucoma.
Methods:
All patients less than 18 years old who were switched from acetazolamide to dorzolamide without other intervention were reviewed. Intraocular pressures were obtained with either a Tono-Pen (Mentor Ophthalmics, Santa Barbara, Calif.) or applanation tonometer. Minimum follow-up times on acetazolamide and on dorzolamide were 1 month (mean 12.2 +/- 19.7 months) and 2 months (mean 8.2 +/- 5.1 months), respectively. The average dose of acetazolamide was 9.9 +/- 1.8 mg/kg/day.
Results:
Eleven eyes (11 patients) were included. Indications for crossover from oral to topical carbonic anhydrase inhibitor (CAI) therapy were intolerance to acetazolamide (6 eyes) and surgical intervention in the fellow eye (5 eyes). The mean age at the time of crossover was 7.4 +/- 3.0 years. A comparison of intraocular pressure (IOP) before addition of a CAI was made in 8 eyes. The mean IOP off of a CAI was 27.8 +/- 4.9 mm Hg. The mean 10P was reduced to 18.5 +/- 4.3 mm Hg on acetazolamide (mean percent IOP reduction 35.7% +/- 15.6%, p < 0.01) and to 22.2 +/- 5.4 mm Hg on dorzolamide (mean percent IOP reduction 27.4% +/- 17.1%, p < 0.01). All 11 eyes showed an increase in IOP when switched from acetazolamide to dorzolamide, with a mean increase of 3.7 +/- 2.5 mm Hg (20.2% -/+ 13.7%, p < 0.01). Five eyes have remained controlled on dorzolamide and a topical beta-blocker. Five eyes required further intervention for the control of glaucoma. One eye was switched back to acetazolamide for better IOP control.
Conclusion:
Although not as effective as oral acetazolamide, topical dorzolamide causes a significant IOP reduction in this group of pediatric glaucoma patients and appears to be well tolerated.