Nitrovasodilators as a new class of ocular hypotensive agents

Because of recent evidence indicating that hormone regulation of particulate guanylate cyclase in the eye may modulate aqueous humor dynamics, we have investigated the possibility that exogenous activators of soluble guanylate cyclase may be useful in altering intraocular pressure (IOP). A variety of nitrovasodilators known to activate guanylate cyclase were evaluated for their topical effects on IOP, outflow resistance and systemic cardiovascular parameters. In both young and older rabbits, topically applied nitroglycerin (0.003-0.1 g %) rapidly lowered IOP in a dose-dependent fashion, with a peak effect at 1 to 2 hr. Topically applied 0.1% isosorbide dinitrate, sodium nitrite, hydralazine, minoxidil and sodium nitroprusside mimicked the ocular hypotensive actions of nitroglycerin. Ipsilateral effects on IOP were greater than contralateral effects and, at the doses applied, there was little or no alteration in heart rate or systemic blood pressure, or signs of ocular irritation. Higher doses (0.5-2.0 g %) of nitroglycerin, hydralazine and sodium nitroprusside were less effective in lowering IOP. Topically applied molsidomine (0.1%), a prodrug which requires hepatic metabolism to 3-morpholino-sydnonimin hydrochloride for guanylate cyclase stimulatory activity, was ineffective in lowering IOP, whereas topical 0.1% 3-morpholino-sydnonimin hydrochloride was effective. After chronic administration, rabbits receiving nitroglycerin showed diminished ocular response, whereas repeated doses of hydralazine (56 days) did not elicit tolerance. Tonographic studies showed that topically applied nitroglycerin and hydralazine increased the facility (decreased the resistance) of aqueous humor leaving the eye. These data indicate that topically applied nitrovasodilators can effectively lower IOP at doses which have little effect on systemic blood pressure. Because these IOP-lowering effects appear to result, to a significant degree, from local actions on the eye, further investigation of these agents in conditions of elevated intraocular pressure may be warranted.