Effect of pH on the ocular distribution of a topical carbonic anhydrase inhibitor

Ampholyte carbonic anhydrase inhibitors (including MK-927) have previously been shown to elicit greater intraocular pressure reduction when applied in ionized form at moderately acidic or alkaline pH compared to application of un-ionized drug at neutral pH. Since ionized solutions should be far more membrane-impermeant than un-ionized solutions, we attempted to solve this apparent paradox. We studied the distribution at 0.5-18 hr of MK-927 in eye tissues and fluid after topical instillation of one drop of a 0.5% solution at pH 4.9, 7.0 and 9.1. Measured drug concentrations at 30 min in corneal epithelium and stroma are approximately 4.5-fold greater after acidic or alkaline application than after neutral application, with the highest levels being found in corneal epithelium. The same pattern is seen in ciliary process, the site of aqueous humor production. Here drug concentration is approximately 60% of that in cornea at 30 min. Free drug concentrations in ciliary process were used to compute the time course of maximal carbonic anhydrase inhibition for the three modes of application. Drug concentration in sclera, uvea and aqueous humor at all times are all low by comparison, suggesting drug movement is from cornea to ciliary process via the corneo-scleral junction. The k(in) for proton movement across the corneal epithelium was measured (k(in) = 12.4 hr-1) from which a permeability coefficient (P = 2.7 x 10(-2) cm sec-1) was computed. Separate analysis was made of the pH status of the cornea 30 min and 1 hr following instillation of 1 drop 2% acidic (pH 4.9) and alkaline (pH 9.1) MK-927, with sodium sulfadiazine and pilocarpine.HCl as pH controls. Stromal bicarbonate at 30 min was approximately halved after acidic drops and doubled after alkaline drops consistent with pH decrease or increase of nearly 0.3 U. The results are in accord with classical schemes for amine permeation of the cornea at acidic pH when consideration is given to movement of acid equivalents and corneal pH. Thus drug inside the eye is in relatively (> 95%) lipophilic form except that trapped in the cornea shortly after acidic or alkaline applications.