[Drug therapy of chronic glaucoma with pilocarpine gel]

In an open clinical trial including 19 patients with chronic open-angle glaucoma, the efficacy, duration of action and tolerance of pilocarpine gel were investigated over a treatment period of a 4 weeks on the basis of one application once a day. The vehicle of pilocarpine gel is a highly viscous, cross-linked, hydrophilic polyacrylic acid which renders prolonged release of pilocarpine hydrochloride 4%, and for this reason insures a prolonged duration of action. After single-dose application pilocarpine gel caused a significant lowering of IOP over at least 18 hours, with a relative potency in the range of 23% of 31% on the first day of treatment, and between 13% and 25% on the 29th day of treatment. As the time interval following the preceding pilocarpine-gel application increased, there was a slight but significant rise in the treated pressure level, although therapeutic pressure levels were not exceeded. In the course of the 4 weeks of treatment, there was a small but significant decrease in response, which can be explained by a certain type of subsensitivity caused by the prolonged release of the active drug. The tolerance of pilocarpine gel was good; side-effects were minor and reversible. These results fulfill the expectations of the glaucoma therapists with respect to both efficacy and tolerance.