What is the preferred first-line therapy of open-angle glaucoma?
topical prostaglandin analogs. Preferred therapy since they can significantly reduce IOP with once-daily dosing without systemic side effects; generally more expensive than alternative topical agents.
Latanoprost (Associated with less conjunctival hyperemia than other prostaglandin analogs)
Travoprost
Bimatoprost
What are alternative options for open-angle glaucoma treatment?
Topical beta blockers alone and/or alpha-2 agonists
Beta blockers
Timolol
Betaxolol
Alpha-2 agonists
Brimonidine
Apraclonidine: generally used perioperatively in patients with refractory glaucoma [5]
Topical carbonic anhydrase inhibitors
Brinzolamide
Dorzolamide
What are options for refractory glaucoma?
oral carbonic anhydrase inhibitors
Acetazolamide
Methazolamide
Which prostaglandin is targeted using Latanoprost?
Prostaglandin F2α (PGF2α)
Describe the function of this Prostaglandin F2α (PGF2α)
Smooth muscle contraction (e.g., increases uterine tone)
Relaxation of the ciliary muscle → increased uveoscleral outflow [
Mechanism of action of Latanoprost?
Decreases resistance through uveoscleral flow
What are side effects of Latanoprost?
Darkening of iris
Growth of eyelashes
Epithelial keratopathy
What kind of drug is timolol?
Nonselective beta blockers (β1, β2, and β3receptors) without ISA
Mechanism of action of Timolol?
Block β1, β2, and β3receptors
Sotalol also blocks cardiac potassium channels (antiarrhythmic effect).
Side effects of timolol?
Bronchoconstriction: may exacerbate asthma/COPD
Vasoconstriction: avoid in patients with peripheral vascular disease
Hypoglycemia and hyperglycemia
Bradycardia and syncope (Hypotension)
No canges in vision or pupil
What is the initial pharmacotherapy in acute angle-closure glaucoma?
Topical ophthalmic therapy. Administer the following eye drops in succession, one minute apart:
Direct parasympathomimetic: pilocarpine
Alpha-2 agonist: apraclonidine
Beta blocker: timolol
PLUS a systemic carbonic anhydrase inhibitor
OR methazolamide
Consider also the following alternatives:
Levobunolol
What is the mechanism of action of pilocarpine?
Direct parasympathomimetic (via M3)
Ciliary muscle contraction
Trabecular meshwork opening (into canal of Schlemm)
Side effects of pilocarpine?
Miosis (via contraction of pupillary sphincter)
Cyclospasm (via contraction of ciliary muscle)
What kind of drug is dorzolomide?
Carbonic anhydrase inhibitors —> Carbonic anhydrase inhibitors
Adverse effects of dorzolomide?
No changes in vision or pupil
Non anion-gap metabolic acidosis
Last changed2 years ago