Systemic Carbonic Anhydrase Inhibitors in Common Ophthalmic Diseases: A Scoping Review from A Clinical Standpoint

Area of Science:

• Ophthalmology
• Pharmacology
• Nephrology

Background:

• Systemic carbonic anhydrase inhibitors (CAIs) are crucial for treating ophthalmic conditions such as glaucoma.
• Concerns regarding severe systemic adverse effects often limit their clinical use.
• Recent research clarifies the roles of carbonic anhydrase (CA) isozymes and systemic CAI mechanisms.

Purpose of the Study:

• To provide a comprehensive review of systemic CAIs in ophthalmic care.
• To examine the pharmacology, pharmacokinetics, safety, and indications of systemic CAIs.
• To highlight strategies for mitigating treatment challenges in patients with comorbidities.

Main Methods:

• Literature review of systemic carbonic anhydrase inhibitors.
• Analysis of pharmacology, pharmacokinetics, and safety profiles.
• Evaluation of clinical indications and treatment strategies.

Main Results:

• CA isozymes (CA-II, CA-IV) play key roles in aqueous humor production and ocular blood flow.
• Maximal intraocular pressure reduction depends on tissue-bound drug concentration.
• Severe systemic adverse events are infrequent, even in patients with comorbidities.

Conclusions:

• Systemic CAIs are vital for vision preservation in specific ocular diseases.
• The incidence of severe adverse events with systemic CAIs is low and comparable to topical therapies.
• Individual risk-benefit assessment and correct usage are essential for safe and effective treatment.