97th DOG Annual Meeting 1999
UPDATE ON MEDICAL TREATMENT IN GLAUCOMA
L. E. Pillunat
Beside the treatment of an increased intraocular pressure, the actual, medical glaucoma treatment requires also the consideration of other pathogenic risk factors.
Hemodynamic aspects (vasospasm, reduced microcirculation) as well as neurodegenerative diseases must be taken into account.
Nevertheless, an increased intraocular pressure represents the most important risk factor in the pathogenesis of glaucomatous optic nerve damage and a wide spectrum of modern IOP - reducing antiglaucoma drugs is available.
Latanoprost, a prostaglandine analogue, represents a new generation of glaucoma medication. It enhances uveoscleral outflow and leads to a potent IOP-reduction (ca. 30 %).
On the other hand dorcolamide is the first topically applicable carbonic anhydrase inhibitor, which shows a considerable IOP-reduction (ca. 25 %) and leads to an improvement of ocular blood flow.
The selective alpha-2-agonist brimonidine has a potent IOP-reductive effect (ca. 30 %) and in animal experiments this drug seems to have some neuroprotective properties.
Beside a topical therapy not pressure lowering drugs are applied. Calciumchannelblockers and magnesium e.g. are administered in glaucoma patients who suffer from ocular vasospasm. Further clinical trials have to show whether an adjunctive therapy with neuroprotective compounds (e.g. NMDA-antagonist) might improve the prognosis and slows down the progression of the disease.
Universitäts-Augenklinik Hamburg, Martinistr. 52, 20246 Hamburg